IFI Community Leadership Programme 2012-13

IFI Community Leadership Programme (CLP) expression of interest Name of group Primary contact name Address of group

Telephone number: Email

Day Mobile

1. When was your group established? 2. How many people are on your board or committee? 3. How many staff do you employ? 4. How many volunteers do you have? 5. What is the annual income of your group?

____ ____ ____ ____

Under 1,000 1,001-10,000 10,001-100,000 100,001-250,000 6. Does your group currently receive IFI funding? Yes No Please specify___________________________________________________

7. Briefly describe the activities of your group.

8. Please tick if you group is involved in the following activities. CLP expression of interest - 2012

IFI Community Leadership Programme 2012-13

Community development Cross border work Cross community work 9. Can five people from your committee/board commit to eight half day or evening sessions and three roundtable events during the year of the Programme (November 2012-October 2013)? Yes No

Please ensure that your committee/board support this expression of interest Name: Date: _______________________________________________________ _______________________________________________________

Please return this form by 31 August 2012 to Community Leadership Programme: clp@nicva.org or CLP Co-ordinator, NICVA 61 Duncairn Gardens Belfast BT15 2GB This is the first stage of the process. When we receive your completed form we will contact you to discuss it. Suitable groups will then be forwarded an application form to be completed. The closing date for final full applications is 25 September 2012. The first roundtable event is planned for early November.

CLP expression of interest - 2012