1Page 1 2Page 2 3Page 3 4Page 4 5Page 5 6Page 6 7Page 7 8Page 8 9Page 9 10Page 10 11Page 11 12Page 12 13Page 13 14Page 14 15Page 15 16Summary Progress Eligibility self-assessment Are you a VCFSE sector organisation (as defined in the grant specification)? Yes No Is your organisation based in Liverpool (not Liverpool City Region)? Yes No Does your organisation match at least one of the identities listed in the grant specification? Yes No Do you have all the policies and procedures you require to function legally and safely? Yes No Do staff/volunteers working with children or vulnerable adults have enhanced DBS checks? Yes No Do you have all necessary insurances? Yes No Do you have a current governing document? Yes No Do you have a business bank account in your organisation's name? Yes No Will you use this grant to support political parties? Yes No Will you use this grant to promote or practise religion? Yes No No information is required, please proceed to the next page. Organisation details What is your organisation’s full name? This is the name in your governing document, or on the Charity Commission or Companies House websites. What is the name your organisation is known as locally? What is your organisation's address? Use your registered address if you are a Registered Charity or Incorporated Company. Use the postcode you run your organisation from if you aren’t. Postcode Find Address Loading addresses... Select Address -- Please select -- Address line 1 Address line 2 (optional) City Postcode Clear postcode/address Use the Lookup Postcode button to find the address.If you cannot find the address, please enter it manually Are you a registered charity? Yes No Charity number Are you a registered company? Yes No Company number Are you a registered society? Yes No Society number What is your organisation's size? Micro (income is less than £10,000 per year) Small (income is between £10,000 and £100,000 per year) Medium (income is between £100,000 and £1m per year) Large (income is over £1m per year) Name of person we should speak to about this application This is the person who is responsible for what is in the application. Job title Email address Phone number No information is required, please proceed to the next page. Organisation Leadership, Mission and Accountability In this section, indicate your organisation's main aims. Anti-poverty and economic justice Is one of your main aims to serve and support people who have lived through poverty or injustice? Yes No Do most of your leaders (like board members, senior staff, or steering groups) have lived experience of poverty or injustice? Yes No Do you listen to and answer to people who have lived through poverty or injustice? Yes No No information is required, please proceed to the next page. Care experience Is one of your main aims to serve and support care experienced people? Yes No Do most of your leaders (like board members, senior staff, or steering groups) have lived experience of being in care? Yes No Do you listen to and answer to care experienced people? Yes No No information is required, please proceed to the next page. Children and youth-led Is one of your main aims to serve and support children and young people? Yes No Are most of your leaders (like board members, senior staff, or steering groups) children or young people? Yes No Do you listen to and answer to children and young people? Yes No No information is required, please proceed to the next page. Criminal justice Is one of your main aims to serve and support people affected by the criminal justice system? Yes No Do most of your leaders (like board members, senior staff, or steering groups) have lived experience of the criminal justice system? Yes No Do you listen to and answer to people affected by the criminal justice system? Yes No No information is required, please proceed to the next page. Disabled people Is one of your main aims to serve and support disabled people? Yes No Do you support people who have Physical Disability Sensory Disability Learning Disability Mental Health Condition Developmental Disability Chronic Illness Do most of your leaders (like board members, senior staff, or steering groups) identify as disabled? Yes No Does your group listen to and answer to disabled people? Yes No No information is required, please proceed to the next page. Faith or religion Is one of your main aims to serve and support people based on the values of your faith? Yes No What is your group’s faith? Christianity Islam Hinduism Sikhism Judaism Buddhism Other Do most of your leaders (like board members, senior staff, or steering groups) follow this faith? Yes No Do you listen to and answer to people who follow this faith? Yes No No information is required, please proceed to the next page. Grassroots community Is one of your main aims to serve and support people from your own community? Yes No Are most of your leaders (like board members, senior staff, or steering groups) from your own community? Yes No Do you listen to and answer to people from your own community? Yes No No information is required, please proceed to the next page. Homelessness Is one of your main aims to serve and support people who are homeless or might lose their home? Yes No Do most of your leaders (like board members, senior staff, or steering groups) have lived experience of homelessness or bring at risk? Yes No Do you listen to and answer to people with lived experience of homelessness or being at risk? Yes No No information is required, please proceed to the next page. LGBTQ+ Is one of your main aims to serve and support people who identify as LGBTQ+ (including intersex, asexual, non-binary, pansexual, and others)? Yes No Do you support people who identify as Lesbian Gay Bisexual Trans* Queer + (e.g. intersex, asexual, non-binary, pansexual and others) Do most of your leaders (like board members, senior staff, or steering groups) identify as LGBTQ+? Yes No Do you listen to and answer to people who identify as LGBTQ+? Yes No No information is required, please proceed to the next page. Migrants and refugees Is one of your main aims to serve and support refugees, asylum seekers and migrants? Yes No Does your group support Asylum seekers Refugees Economic migrants Do most of your leaders (like board members, senior staff, or steering groups) identify as being a refugee, asylum seeker or migrant? Yes No Does your group listen to and answer to refugees, asylum seekers and migrants? Yes No No information is required, please proceed to the next page. Racially minoritised Is one of your main aims to serve and support people who identify as racially minoritised? Yes No Do you support people who identify as Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Chinese Any other Asian or Asian British background Black or Black British - Caribbean Black or Black British - African Any other Black or Black British background Mixed - White and Black Caribbean Mixed - White and Black African Mixed - White and Asian Any other Mixed or Multiple ethnic background White - Irish White - Gypsy or Irish Traveller White - Roma Any other marginalised white background Other Ethnic Group - Arab Any other marginalised ethnic group Do most of leaders (like board members, senior staff, or steering groups) identify as racially minoritised? Yes No Do you listen to and answer to people who identify as racially minoritised? Yes No No information is required, please proceed to the next page. Women and girls Is one of your main aims to serve and support women and girls? Yes No Are most of your leaders (like board members, senior staff, or steering groups) women and girls? Yes No Does your group listen to and answer to women and girls? Yes No No information is required, please proceed to the next page. Motivation, contribution and lived experience Why does your organisation want to help create the strategy? How can your organisation help make the strategy fair and inclusive? What lived experience does your organisation have of being left out of decisions? Declaration Declaration I confirm that the information provided in this grant application is true and accurate and that I am authorised to submit it. I understand your obligation under General Data Protection Regulation (GDPR), the Data Protection Act 2018 and the Freedom of Information Act 2000. No information is required, please proceed to the next page. Before you submit this form please review your answers below. 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