Associate registration of interest

Section 1: About you

1 - Name:

2 - Address:

3 - Email:

4 - Phone:

5 - Website:

6 - Linkedin:

7 - Twitter:

8 - Do you operate as a business?:
Select optionYesNo

Section 2: About your company

9 - Company type (if applicable):
--- Choose your company type ---Registered CharityCommunity Interest CompanySole traderPartnershipCompany Limited by SharesCompany Limited by GuaranteeRegistered CharityOther

10 - Company/Charity name (if applicable):

11 - Company/Charity Registration number (if applicable):

12 - Company/Charity address (if applicable):

Section 3: Associate information

13 - Day rate – Standard:

14 - Day rate – Consultancy (if applicable):

15 - Day rate – Training and Workshops (if applicable)

16 - Do you charge VAT?
Select optionYesNo

17 - Average weekly availability for assignments (hours):

18 - What is your area(s) of expertise? Tick all that apply:
Change and transformation programmesChild protection and safeguardingDesign and mediaEquity, Diversity and Inclusion (EDI)Other / none of the aboveHuman ResourcesLeadership and managementOrganisational developmentViolence Against Women and GirlsOther

19 - If Equality, Diversity and Inclusion (EDI) selected as an area of expertise, please complete the following question:

19a - Which area(s) of EDI do you cover?
GeneralDisabilityFaith and beliefGenderLGBTQNeurodiversityRace/ethnicityTransothers

19b - Which audiences / areas do you work with?
Children and young peopleCommunitySystems and PartnershipsWorkforceothers

20 - If other selected or none from the above applies, then state below:

21 - Which of the following do you deliver? Tick all that apply:
Auditing and reviewingCoachingConsultancy (Advice, guidance, projects, reports etc)FacilitationResearch and analysis - qualitativeResearch and analysis – quantitativeTrainingOther
22 - If none from above applies, then state below:

23 - Please provide a short bio of yourself – this should include an overview of your personal and/or professional background and experience relevant to this associate role and current role, and be no more than 175 words

1250

24 - Please upload a picture of yourself – this should be suitable for a professional associate profile should you be successful:

25 - Do you consent to being featured on the LBTC website (bio and picture), should your registration be successful?
YesNo

26 - Compliance - select those you have
Public Liability InsuranceProfessional Indemnity InsuranceGDPR policySafeguarding policyCurrent DBS certificateEDI related qualificationChild protection/safeguarding related qualificationAt least 3 client references from the past 6 monthsOther qualificationEDI policy

27 - Most recent CV:

Please check the box below to proceed: