Shackleton Foundation Leadership Award Application Form

Leadership Award Application Form
The Shackleton Foundation supports individuals rather than projects. We seek to identify Leaders who have a challenging idea (we call it their ‘Antarctic’) about which they are passionate, and believe they can make a difference, to disadvantaged and socially marginalised young people in the UK. With that in mind we want to get a feel for you as a person; as a Leader; and to understand what your ’Antarctic’ is, why it’s important to you, and why you need our financial support.

Please do not complete this form until you have read the Foundation’s grant-making guidelines.

You may start filling in the form, save it and resume later. To do this, scroll to the end, and press 'SAVE'.

An asterix (*) denotes a compulsory field.
Section 1 - About You
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Email*
Phone number*
How did you hear about the Shackleton Foundation?*
Do you have a previous connection with the Shackleton Foundation or any of its Trustees?*

NoYes
Please specify the connection*
Have you applied before to the Shackleton Foundation?*

NoYes
Please specify date of initial application and the organisation name if different to this one*
What do you think makes you a Leader? (max 200 words)*

0/200
Do you have any 'lived experience' of the issue that your project addresses?*

NoYes
Please provide some details of your 'lived experience' (max 100 words)*

0/100
In order for us to make fair and equitable decisions is there anything you would like us to know about you before we assess this application? (max 100 words)

0/100
Section 2 - Your Project. What is your 'Antarctic'?
Project name*
Provide a very brief description of your project (max 20 words)*

0/20
Website Address*
Charity number (if applicable)
Company number (if applicable)
Legal Status*

Registered charity (limited by guarantee)Community Interest Company Limited by Guarantee (CIC-CLG)Charitable Incorporated Organisation (CIO)Community Interest Company Limited by Shares (CIC-CLS)Company (limited by shares)Company (limited by guarantee)Unincorporated AssociationOther
We only provide awards to private limited companies that either have an asset lock in their governing document or a clear mission statement. Please upload evidence of either an asset lock or mission statement.

Cancelof
What date was your organisation registered? If you have not yet gained legal status, please provide an estimated date in the future?*

DayMonthYear
Date
Location of project*

UK-wideAcross EnglandEast of EnglandEast MidlandsGreater LondonNorth-East EnglandNorth-West EnglandSouth-East EnglandSouth-West EnglandWest MidlandsYorkshire and the HumberNorthern IrelandScotlandWales
Sector*

Community Services & Social WelfareEducationLife Skills & EmployabilityMental HealthPhysical HealthYouth OffendingOther
Has your project already started?

YesNo
What date did your project start?*

DayMonthYear
What date is your project due to start?*

DayMonthYear
What is the social issue you are addressing? (max 200 words)*

0/200
What are the main activities or services your project carries out, or will carry out, to address this issue? (max 300 words)*

0/300
Who will be delivering this project? (max 50 words)*

0/50
What sets this project apart from others trying to address this same issue? (max 150 words)*

0/150
How do you know that your approach is meeting a real need (beyond your personal experience)? (max 150 words)*

0/150
How many disadvantaged young people do you expect to benefit from your project in the next 12 months? (max 50 words)*

0/50
What are the main outcomes that you aim to achieve with this project? (max 150 words)*

0/150
How will you measure the outcomes of your activities? (max 150 words)*

0/150
How much funding are you seeking from the Shackleton Foundation?*

How much will your project cost in total? Please provide a breakdown of expense items, costs and the amount of each item to be covered by the Shackleton Foundation. Please complete the table below, but leave rows blank if necessary.*

Rows	Expense name	Total cost	Amount to be covered by Shackleton
1
2
3
4
5
6
8
9
10
Total Expenses

What % of your overall project costs will our funding represent?*
What other sources of funding have you identified/approached/secured? Please provide details of any funding already secured for this project (funder name and amount of funding).*
How do you see this project becoming financially sustainable in the long-term? (max 150 words)*

0/150
What will happen to your project if you are not successful with this application? (max 150 words)*

0/150
How much time (hours per week) will you commit to this project, and will others be working on the project - if so, who, for how many hours and paid or voluntary? (max 150 words)*

0/150
Section 3 - References

Please provide the names and addresses of two referees. Referees should have known you for at least one year, and know and support your project / organisation. Referees should not be involved in the project and should not be directly related to you.
Referee One*
Referee Two*
Section 4 - Equity, diversity and inclusion monitoring

The Shackleton Foundation promotes equity, diversity and inclusion, and we are committed to selecting Leaders from all backgrounds. We want to build an accurate picture of the make-up of our applicants, to ensure we are reaching applicants across all protected characteristics. Completing this section has no bearing on the success of your application. The information will be solely used for fairness monitoring, and will not be published or used in any way which allows individuals to be identified.
Which best describes your gender?*
Ethnicity - please select the option that applies to you*
2021 Census: List of ethnic groups
Disability - do you consider yourself to have a disability (including neurodiversity)?*
By submitting this application form I confirm that :
- all the information contained in this application is accurate
- I have read the Shackleton Foundation grant-making guidelines
- I have in place an up-to-date safeguarding policy that is relevant to my project's beneficiaries
Should be Empty:

Leadership Award Application Form

Section 1 - About You

Section 2 - Your Project. What is your 'Antarctic'?

Section 3 - References

Section 4 - Equity, diversity and inclusion monitoring