Please provide the details of the individual applying to be a member of the Community of Practice
1. First name * 2. Surname * 3. Work e-mail address * 4. Work telephone number 5. Position/Job Title * Organisation details
Please provide details of the organisation for which the individual applicant works
6. Organisation name * 7. Organisation registered address * 8. Organisation postcode * 9. Organisation e-mail * 10. Organisation charitable purpose * Advancement of education Advancement of religion Advancement of health or the saving of lives Advancement of citizenship or community development Advancement of the arts, culture, heritage or science Advancement of amateur sport Advancement of human rights/conflict resolution/ reconciliation/ promotion of religious/ racial harmony/ equality and diversity Advancement of environmental protection or improvement Relief of those in need, by reason of youth, age, ill-health, disability, financial hardship or other disadvantage Advancement of animal welfare Promotion of the efficiency of the armed forces of the Crown, or of the efficiency of the police, fire and rescue services or ambulance services Any other charitable purposes
Please select your charitable purpose
10a. If other please specify 11. Please indicate briefly how your organisation meets, or is progressing towards, each of the four community business criteria. It is not necessary that your organisation can currently demonstrate how it meets each of the criteria, however you will need to how your organisation intends to progress towards each Locally Rooted *
Demonstrate how your organisation is rooted in a particular geographic place and responds to its needs
Accountable to the local community *
Whether through a community share offer, membership, legal structure or regular community consultation, you do - or have plans to - give local people real, ongoing decision making power to shape the business
Generating trading income *
You are or you aspire to be a business with a clear trading model, selling services or products to people in your local area, with profits used to deliver local benefit. All or part of your income comes from activities, for example running services or selling the produce you grow
Broad community impact *
Your organisation will benefit the community as a whole, and you can clearly evidence the positive social impact that your activities have on the broader community. It will be inclusive, and give opportunities for people with different abilities and backgrounds to get involved.
Community of Practice practitioner
The following questions are exploring the skills and experience of the nominated practitioner and exploring the potential suitability of becoming an active member of the CoP
Please outline the experience of the nominated practitioner in health and/or social care service delivery at a senior or managerial level and experience of business models and income generation. This section is to demonstrate understanding and knowledge of the individual
13. Engagement with the CoP
Please explain what you hope to get out of the CoP and what you would put in place to ensure you could attend the face-to-face meetings and contribute in between
Organisational health and social care activity
In this section we want to understand more about the types and models of health or social care delivery used at your organisation. This will, in part, enable us to get a balance of organisations engaged in the Community of Practice whilst maintaining shared interest at the core of the Community of Practice. We are also interested in your organisation’s business models and income streams
14. Health and social care services
Please describe the health and/or social care services delivered by the organisation. Include the specific activities, who the beneficiaries are and the funding sources. Think about commissioning/procurement, grant funding, self-funder and personal budgets and any other source of funding such as cross-subsidisation from other income sources.
Please add a new box for each different service.
Outline the main challenges your organisation faces in relation to the delivery of health and/or social care services.
16. The future
Outline your organisations plans/ambitions for its future delivery of health and social care services
17. How did you find out about the community of practice? Power to Change website Power to Change newsletter Power to Change twitter Existing community of practice member Other 17a. Please specify if other Organisational support
We want to seek assurance that the individual nominated practitioner has the broader support of their organisation to both be an active participant in the CoP and to be supported to implement learning in broader organisational practice
18. Trustee/director letter of support *
Please submit alongside your application a letter of support from a director or trustee of the community business which details that, if successful, the practitioner will be supported to engage actively with the CoP through releasing their time to do so. This letter should also express support for the individual to share the learning from the CoP within the organisation to influence its practice
Equality and diversity
Power to Change is committed to the advancement of equality, diversity and inclusion. It seeks to be a genuinely inclusive organisation by advancing equality and diversity through its policies and practices. We encourage and welcome applications from individuals from all backgrounds, who meet our criteria, and who are looking to improve the impact and sustainability of community-led/shared ownership delivery of health and social care services
Please follow the link to complete our anonymous diversity and inclusion monitoring form. The information you enter on this monitoring form will not be used in assessing and or scoring your application, nor will it be seen by any person involved in selection of membership for the community of practice. We will not publish or use the information in any way which allows any individual to be identified. This information is kept fully confidential and accessibility is strictly limited in accordance with the Data Protection Act and our Data Protection Policy, please please click here. We want to ensure our activities are open to everyone. Do you have any accessibility concerns about the format we are planning to use in our sessions: Please let us know any reasonable adjustments we can make to enable engagement: Data Protection
We will use the information you give us during assessment and during the life of the project (if successful) to administer and analyse projects and for research purposes. We may give copies of all or some of this information to individuals and organisations we work with when assessing applications, administering the programme, monitoring grants and evaluating funding processes and impacts. We have a duty to protect charitable funds and for that reason we may also share information with other organisations for the prevention and detection of crime including fraud and money laundering.
To read our data protection policy please click here.
* Communication preferences
We will contact you via email or phone to let you know the outcome of your application. We’d also like to keep in touch with your organisation about Power to Change news, including information about new funding programmes. We will never share your information with third parties for marketing purposes. Please let us know what you prefer to be contacted about.
Please tick each of the declarations below to confirm that you have read, understood and agree to them. Your application will not be eligible unless all boxes are ticked.