Expression of Interest to undertake community engagement in support of the NHS

3. Your organisation
Which NW London borough(s) do you work in? (you can select multiple options)

Brent Harrow Hounslow Hillingdon Ealing Hammersmith and Fulham Westminster Kensington and Chelsea
Please give a brief description of your organisation, thinking about the following areas: Aims and objectives; Services you provide; Who you usually work with (your services users/beneficiaries); How many committee members, paid staff and volunteers the organisation has; Recent achievements; What arrangements your organisation has in place to ensure you are delivering good quality services (Max 500 words)

4. Proposed activity
Which project are you looking to support? (select just one option – please use a separate application for each project)

Winter (brief can be found at https://www.nwlondonics.nhs.uk/get-involved/EOI)
Which areas of the borough(s) would you target?
Which demographics would you target?
Would you undertake engagement activity in any other languages? Please specify which ones if so.

Please provide us with your proposal of the activity you would undertake if you were successful in your application. You do not need to answer all sections – please pick the one most appropriate for your organisation. In answering this question, please include:

·         Planned activity including a breakdown of costs where possible

·         Proposed timeframe

·         How many people you anticipate meeting

·         What success would look like for you.
4a. With a £1000 grant (Max 500 words)
4b. With a £2000 grant (Max 500 words)
4c. With a larger grant – up to £5000 (please specify the amount you propose)(Max 500 words)

5. Your track record
Have you received public sector grants to undertake work with the community previously?

Yes No
If so, please give an overview of what you have done in the past, how successful it was, and the value of those grants. (Max 200 words)

Further information
In the space below write any points you want to bring to the attention of NHS NW London. (Max 200 words)
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Yes No
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