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* Name of organisation

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* Type of organisation

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* Contact details

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* To help us understand more about your organisation/group, please select the communities/protected characteristics which are the PRIMARY focus of your work from the list below.

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* Please select any other communities/protected characteristics which benefit from the work of your organisation/group

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* Estimated numbers (potential numbers of people you could reach through engagement activities)

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* Special interests - i.e. any particular health issue or community issue

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* Geographic Audience - the postcodes that you cover

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* What is your preferred method of engagement?

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* Would you require any support in delivering engagement activities?

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* If yes, what support do you feel you would need in order to enable you to do this?

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* Are you interested in getting more involved in helping us to design engagements which meet the needs of your clients/communities?

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* Eligibility Statement - in order to join the Engaging Voices project you need to have, or be working towards, the following (please select as appropriate)

  Already in place Working towards
Constitution/governing document (must already be in place)
Safeguarding policy and procedures
Public liability insurance
Employers liability insurance (if applicable)
Equality policy
Health & Safety policy
Bank Account

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* Date

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* On behalf of (name of organisation)

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