Community Connections - Connectors Expression of Interest Form

Community Connectors

Expression of Interest Form

Please complete this document fully to allow us to gather the relevant information needed to be able to process your expression of interest for involvement in our Community Connectors programme.

As a volunteer Community Connector you will play an integral part in the delivery of our programme. We hope to utilise your skills and knowledge to welcome and support people from different communites who now live in Belfast.

Once we have assessed this information we will be in contact with you to discuss the next stages and ensure you are ready to engage with our programme.

Recruitment for connectors is open and will be managed in cycles, if you do not hear from us shortly after your expression is completed please contact us via email or phone.

For further information please call GEMS NI on 02890 332313 or email stephen.atkinson@gemsni.org.uk

1. Please enter your full name

First NameLast Name

2. Please provide a valid email contact

example@example.com

3. Please provide your current address including post code

Street Address

Street Address Line 2

CityCounty

Post Code

4. Please provide your phone number

Please enter a valid phone number.Format: 00000000000.

5. Are you aged 18+ and living in Belfast

6. Please tell us your nationality

7. Do you have photographic identification with your full name, date of birth and resident status (we may need to take a copy of this for programme registration)

8. Do you have any previous experience providing volunteering in the community?

If you answered yes, please tell us about this

9. Please tell us why you are interested in this programme?

11. Date Completed

Date

10. Declaration - I confirm that the information provided in this form is accurate and complete to the best of my knowledge. If successful, I agree to be able to commit to the full schedule of the programme (approximately 30 hours over 6 months). I also confirm that I give my permission for you to hold this information for the purposes of expression of interest in the future.

Completion of this form will help us to check your eligibility. Spaces are limited. We will keep your details on record and let you know if you are successful. Should a place become available we may be in position to offer you this and will be in touch.

Thank you for completing this form we will be in contact with you again shortly to discuss next steps.