Partnership Application to Harrow Community Action To become a Harrow Community Action (HCA) Partner please complete this form only. On completion of this form (stage 1) organisations will be assessed and where appropriate be invited to complete stage 2. Question Title * 1. Organisation Name Question Title * 2. Contact name: Question Title * 3. Organisation Address Question Title * 4. Phone Number Question Title * 5. E-mail address Question Title * 6. Website Question Title * 7. What is your legal status? (please tick all that apply) Charitable company Charitable incorporated organisation Company limited by guarantee Community Interest Company Industrial & Provident Society Registered charity Residents Association Trusts Other (please specify) Question Title * 8. Approximately how much of your work is delivered in Harrow / for the benefit of Harrow residents? 100% 80-99% 60-77% 40-59% 20-39% 0-19% Question Title * 9. What does your organisation do? (please tick all that apply) General Charitable Purposes Education/Training The Advancement Of Health Or Saving Of Lives Disability The Prevention Or Relief Of Poverty Overseas Aid/Famine Relief Accommodation/Housing Religious Activities Arts/Culture/Heritage/Science Amateur Sport Animals Environment/Conservation/Heritage Economic/Community Development/Employment Armed Forces/Emergency Service Efficiency Human Rights/Religious Or Racial Harmony/Equality Or Diversity Recreation Other (please specify) Question Title * 10. Who does your organisation help? Children/Young People Elderly/Old People People With Disabilities People Of A Particular Ethnic Or Racial Origin Other Charities Or Voluntary Bodies Other Defined Groups The General Public/Mankind Other (please specify) Question Title * 11. Do you have a track record of working with vulnerable, marginalised and excluded individuals and communities? Please give an example. Question Title * 12. How do you involve your service users or local communities in the planning and monitoring of your services e.g. feedback forms. Done