Coaching and Action-Learning
Application Form
BASIC DETAILS
Name:
Organisation name (if
relevant):
Job title (if relevant):
If you are freelance,
please state your main
area of activity:
Address:
Region in which your
organisation is based:
East / East Midlands / London / North East
North West / South East / South West
West Midlands / Yorkshire (please circle as
appropriate)
Other (please state):
Main telephone number:
Email:
Do you have any access
requirements for
participating in the
training? If so, please
give us some
information. We may
also contact you to
discuss these further.
Is your organisation an
Arts Council England
National Portfolio
Organisation?
Which artform/s would
you consider to be your
organisation’s, or your,
main area of focus?
YES/NO (please delete as appropriate)
FURTHER INFORMATION:
YES/NO
COMBINED ARTS / DANCE / LITERATURE /
MUSIC / THEATRE / VISUAL ARTS (please circle
as appropriate)
OTHER (please state)
FURTHER DETAILS
Please note that we are not able to offer any payment towards travel or other
costs in relation to your participation in this programme.
We will offer Coaching and Action Learning training opportunities to individuals
who meet the following criteria:
 At least five years’ arts management / leadership experience
 Currently in a leadership role within the arts, either leading an
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organisation or a development team
We will also consider the following when making our decisions:
 The benefit of participating in this programme for the individual
 The benefit of participating in this programme for the arts organisation
they are currently based in, or for the arts sector as a whole if they are
freelance
We want to offer coaching to people from across the arts sector in England,
and will take into account information on the applicant, and the scale and type
of organisation they work for, when making decisions.
Action-learning training
If you are accepted on to the Arts Fundraising and Philanthropy Coaching
Programme, you will automatically receive a place on an Action-Learning
Training Session. Information on this session will follow. Please tick below if
you do not wish to take part in an Action-Learning Training Session.
I do not wish to take part in an Action-Learning Training Session_______
Please give a brief outline of your career history to date, including your current
job, paying particular attention to your work in arts fundraising. Please include
the details of the type and size of organisation you are currently working in.
[500 words maximum.]
Please briefly explain how you would benefit from a place on the Coaching
and Action Learning programme. [300 words maximum.]
Please explain briefly how you feel your organisation, or, if you are freelance,
your work within the arts sector, would benefit from your Placement on the
programme. [300 words maximum.]
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DECLARATION
I hereby consent to Arts Fundraising & Philanthropy processing the data on
this form, and (if applicable) subsequent data collected during the
administration of my participation in this course in line with the requirements of
the Data Protection Act 1988.
I confirm that the information given on this form is to the best of my knowledge,
true and complete.
Signature:
Date:
Electronic submissions: For persons submitting applications by email please
type your name and the date above. These details, together with your
attached email, will be deemed to form an electronic signature.
Please email your complete form to katrina.black@cause4.co.uk.
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Arts Fundraising and Philanthropy Programme
Equality monitoring form
Any information you provide here will only be used for monitoring purposes. We will take steps to
ensure this information remains confidential to a limited number of staff.
Name ……………………………………
Ethnicity
How would you describe yourself?
Please circle the appropriate bullet point.
A. Asian or Asian British
a. Bangladeshi
b. Indian
c. Pakistani
d. Any other Asian background, please specify:
B. Black or Black British
a. African
b. Caribbean
c. Any other Black background, please specify:
C. Chinese or other ethnic group
a. Chinese
b. Any other, please specify:
D. Mixed Heritage
a. Asian and White
b. Black African and White
c. Black Caribbean and White
d. Any other Mixed background, please specify:
E. White
a.
b.
c.
d.
e.
f.
British
English
Irish
Scottish
Welsh
Any other White background, please specify:
F. Prefer not to say
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Disability
Do you consider yourself to have a disability or a long-term health condition? (Please delete as
appropriate) YES / NO
Do you have rights under the 1995 & 2005 Disability Discrimination Act? (Please delete as
appropriate) YES / NO
Gender
How would you describe yourself?
Please circle the appropriate bullet point.
A. Male
B. Female
C. Prefer not to say
Sexual orientation
What is your sexual orientation?
Please circle the appropriate bullet point.
A.
B.
C.
D.
E.
F.
Bisexual
Gay man
Gay woman/lesbian
Heterosexual
Other
Prefer not to say
Age
What is your date of birth? ------------------------------------------
Religion and belief
What is your religion or belief?
Please indicate the appropriate bullet point.
A. Religion or belief (please specify) …………………………………………
B. No religion
C. Prefer not to say
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