City of Westminster

COMMUNITY COMPUTERS CHARITY APPLICATION FORM

 
Please complete the form below. If you have any difficulties please email Community Computers

 * 
  Contact Details
  First Name *   
  Last Name *   
  Contact Tel No 1 *   
  Contact Tel No 2  
  Email Address *   
                   
  Organisation Details
  Name of Organisation * 
  Address of Organisation * 
  Post Code * 
  Website
  Registered Charity Number * 
  Size Of Organisation:
  Number Of Paid Staff * 
  Number Of Unpaid Staff * 
  Annual Revenue Turnover * 
  Type of work your organisation undertakes (e.g. youth work, training for the third sector, advice to unemployed residents etc)  * 
  You must complete all details marked with an asterisk ( * ).  
 
  Essential Criteria
  Organisations should be able to comply with ALL the following statements
Please tick to confirm compliance. *  		 
  You deliver a service for the benefit of the residents of Westminster  * 
You are a registered charity  * 
You will locate the computers in an accessible place and ensure access is given to your clients  * 
You undertake to dispose of the equipment in a responsible and environmentally friendly manner  * 
If your Organisation ceases to operate within 5 years, then you should return the computer to WCC’s agents  * 
You have a written equal opportunities policy statement,please attach  * 
You will give access to WCC Officers to view any equipment received at all reasonable times  * 
  [please attach your Equal Opportunity Statement here]  *      
 
  How the computers will be used
  Westminster City Council would like the use of the computers to directly contribute to one or more of the following.
Please tick appropriate boxes. (one or more to be ticked)		  
  To provide IT training for the Third Sector
To provide access to an ICT room for small organisations that cannot afford or have minimal space for a computer
To benefit a charitable organisation with an income less than £50k per annum
To improve leisure or training based activities that benefit local community groups
To provide training for job-seekers
  
 
  Computers required
  Please state the number and type you would prefer:  
    PC Desktop:  
    Laptop:  
 
  Computers for training purposes
    Organisations that would like to use the computer(s) to provide training should complete this section.  
 
  Title and purpose of training course(s) :   
  Venue of training, if different to the organisation's address :
 
    Course duration :   Number of course participants :         
  Accreditation To Be Acquired :  
 
 
 
  Title and purpose of training course(s) :   
  Venue of training, if different to the organisation's address :
 
    Course duration :   Number of course participants :         
  Accreditation To Be Acquired :  
 
 
 
  Title and purpose of training course(s) :   
  Venue of training, if different to the organisation's address :
 
  Course duration :   Number of course participants :         
  Accreditation To Be Acquired :  
 
 
  Declaration
  I agree to abide by the aforementioned criteria.
To the best of my knowledgethe information provided on this application form is correct.
If Westminster City Council agrees to provide my organisation with equipment, this will be used exclusively for the purpose described.