This is a pdf document
It can be downloaded and printed.
Please then sign the form.
Your initial application form must be completed and emailed
to [email protected]
or delivered by hard copy to Jeff Willmore, Project Co-ordinator
The Research and Business Development Office
Oxford Brookes University
Buckley Building
Gipsy Lane
Headington
Oxford OX3 0BP
Entries open Monday 6 January and close on Friday 31 January 2014,
and there are no exceptions to this.
If you need any assistance contact either
Jeff Willmore - [email protected]
Project co-ordinator, Research and Business Development Office
or your faculty champion.
Faculty of Business
Roberto Daniele - [email protected]
Faculty of Health and Life Sciences
Lynette Basha - [email protected]
Faculty of Humanities and Social Sciences
Marc Howe - [email protected]
Faculty of Technology, Design and Environment
Alison Honour - [email protected]
Application Form
Oxford Brookes Social Entrepreneur Award (OBSEA)
Do It Award
If you need assistance filling in this form, please contact
[email protected] or call 01865 484380 If completing by hand
please write clearly in black ink or in ballpoint pen.
You can continue on a separate sheet if necessary.
A
About you
1
Personal details
First name:
Reference number:
Date stamp:
(Staff use only)
Surname:
Project name (if you have one):
Home address and postcode:
University contact details (course, school, faculty etc)
Phone (home):
Phone (day/work):
Phone (mobile):
Date of birth:
National Insurance Number:
Email address:
/
/
Please note: We only use National Insurance numbers to check with UnLtd that you have not applied before. We will not use them for any other purpose.
If you do not have a National Insurance number, we will use your last name or date of birth (or both).
Which of the following best describe/s your position in the university?
Tick all that apply

Undergraduate student

Postgraduate student

Recent graduate

Academic staff

Professional/administrative staff

Other (please specify) …………
Are you applying as an individual or as part of an informal group?
Please tick appropriate box

On my own

Part of a group

Role in a group
If relevant, what is your main academic discipline or area of study?
Please tick one only

Agriculture, veterinary and food science

Anthropology and development studies

Architecture/built environment/planning

Biological sciences

Business and management studies

Chemistry/physics/environmental sciences

Communication, cultural and media studies, library and information management

Computer science/informatics

Creative and performing arts/design

Education

Engineering

Geography, environmental studies and archaeology

Humanities

Law

Mathematical sciences

Medicine, public health and health care

Psychology, psychiatry and neuroscience

Social work and social policy

Sociology, politics and economics

Sport and exercise sciences, leisure and tourism

Not applicable

Other (please specify) ………………………
Have you previously been the recipient of an OBSEA Award?

Yes

No
If ‘Yes’, please provide a brief description of the project and tell us the
name
2. About your project
1. Please provide a brief description of your project, including the main objectives and benefits
to the wider community.
2. Please provide details about your background, including any previous involvement in
community activities.
3. Please tell us why you want to develop this project. What are your
main reasons for being involved?
4. Please outline the anticipated learning points, along with what you hope to gain by
undertaking this project?
5. How do you know that there is a need or demand for your project?
6. What support (skills development/ mentoring) would be beneficial in order to make your
project a success?
7. Please outline the financial requirements of your project. For a Do It Award the maximum we
can award is £5000
Item of expenditure
Amount needed
£
£
£
£
Tell us if you also need to raise from other sources.
Other (please detail)
£
£
£
£
What type/s of benefit will you create?
Please tick any that apply.

Education

Employment and skills

Housing and shelter

Access to basic services and utilities

Access to finance and legal services

Mental health

Physical health

Social cohesion

Environment

Other – please specify
Who will benefit as a result of your activities?
Please tick any that apply.

Children and families

Young people

Adults in need

Older people

People with disabilities

People with high-risk behaviours, e.g. (ex-) offenders, people with addictions

Communities

Other – please specify
Is your venture new or is it already set up?

New

Already set up
How do you intend to use the Award? Please tick all that apply









Market research

Marketing – website development
Marketing - other than website development
Product development

Property purchase/refurbishment
Purchase of new equipment
Running/operating costs
Legal costs (establishing legal forms/governance arrangements)
Living expenses

Training in a skill needed for my venture
Other (please specify)
Don’t know
What impact do you expect the Award to have on you and your venture? Please tick all that apply

Development of my idea

✔






Establishment of legal form/governance arrangements
Development of operational capacity – systems and products
Development of operational capacity – employment of staff
Increased geographical operation 
Increased financial sustainability
Increased investment readiness 
Increased networks and contacts
Other (please specify)

Don’t know
Development of my skills
C References
14 You should provide the names and addresses of two referees. Referees should know you and
support your project idea and can be a community worker, a teacher, a doctor or someone else of
prominence within the community. Please note that one of the referees must be a
responsible member of staff from Oxford Brookes University e.g. Head of department or
Head of school. They will be contacted to cross-check that they fully endorse and
support your project.
If you would like to apply as a group, please ensure that the referees are familiar with all of
the members of the group.
Referee 1
First name:
Surname:
Job title:
Address and postcode:
Contact number:
Email:
Referee 2
First name:
Surname:
Job title:
Address and postcode:
Contact number:
Email:
Marketing and the OBSEA award
How did you find out about the award you are applying for?
Please tick one box that best shows what prompted your interest in the award
✔
University staff member or student

UnLtd staff member

Another UnLtd Award Winner

Another organization or individual

Oxford Brookes University website

UnLtd website

Another website (please specify)……………………

Leaflet or poster

Newspaper

Radio or TV

Marketing email/mailshot

Social media (e.g. Facebook, Twitter, LinkedIn)

Event

Other (please give details)………………………………………………………..
D Equal Opportunities
All out staff, clients, partners, suppliers and any other person who we work with must follow our equal
opportunities policy and not to discriminate against anyone for any reason. Please help us monitor this
policy by giving us the following details. We will use the information we ask for on these sheets solely
for statistical purposes, and it will not form part of your application assessment. We will separate this
sheet from your application form when we receive it.
Gender

Male

Female
Disability
Are your day-to-day activities limited because of a health problem or disability that has lasted, or
expected to last, at least 12 months?

Yes, limited a little

Yes, limited a lot

No
Ethnic Group
Please tick one box that best describes your ethic group.
White

English/Welsh/Scottish/Northern Irish/British

Irish

Gypsy or Irish Traveller

Any other White background
Mixed/multiple ethnic groups

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed/multiple ethnic background
Asian/Asian British

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background
Black/African/Caribbean/Black British

African

Caribbean

Any other Black/African/Caribbean background
Current employment status
Please tick one box which best describes your main current occupation.

Employed full time

Employed part time

Self-employed

Volunteering

Unemployed

Looking after home or family

Unable to work owing to sickness or disability

Retired

In full-time education

Other, please specify
Qualifications
Please tick one box that describes your highest level of qualification.

No formal qualifications

NVQ 1, intermediate 1 national qualification or equivalent

GCSEs, intermediate GNVQ, NVQ 2, intermediate 2 national qualification or equivalent

A levels, advanced GNVQ, NVQ 3, higher or advanced higher national qualifications or equivalent

HND, Degree and Higher Degree level qualifications or equivalent

Other qualifications, including foreign qualifications
Data protection statement and declaration
By accepting this award, you agree that details about you and the award you have received will be
shared with Oxford Brookes University and UnLtd. Oxford Brookes University, UnLtd and organisations
working on their behalf may contact you for further information about your award experience.
Oxford Brookes University and UnLtd may share some of the information you have provided with other
organisations help them run, fund and research support for social entrepreneurs. Oxford Brookes
University and UnLtd will never share sensitive personal data that could identify you as an individual
without your express consent.
Please sign here to confirm that you have read and understood this statement.
Signed
Date
UnLtd and organisations working on UnLtd’s behalf may contact you in future to share news and offer
relevant opportunities for funding or support. If you do not want to be contacted for these purposes,
please tick this box .
15 Your signature
I confirm that as far as I know, all the information on this application form is true and correct. I
understand that I may be asked for more information at any stage of the application process or
when the project is running.
Your signature:
Date:
(If stamped) Please return completed application form to:
Data Protection Act 1998
UnLtd and the Millennium Awards Trust collect and share elements of this information with
other organisations for research, educational, training administrative and funding purposes, and
to ensure that the Fellowship and Trust comply with regulations and required standards.
Statistics will be gathered to monitor provision and to plan future provision. We do not trade or
share our mailing lists with any other body.
To be completed by Oxford Brookes University Staff
Date award made
Value of award
Staff comments here
Type of award made

Try It

Do It

Build It

Other (please specify)

Confirm Terms and Conditions form issue and signed. Please attach to this document