Trustee Application Form

Please complete the Trustee application form and return it together with your CV 
Email: admin@anahproject.com
Or post to: PO Box 548, Bradford, BD1 5YX

Date

Your details

Full name

	

Address

		

Telephone 

Email

Summarise why you want to become a Trustee of Anah’s Board of Directors and how you can contribute to the work of Anah

	

Please indicate what skill / facilities you can offer to Anah project

In this section, please give demonstrable examples wherever possible to support your application:

	

Personal history and relevant experience 
Please comment on any experience – paid or unpaid do you have that you feel will be relevant to the role of a Trustee?

	

     

References	

Name of referee 1

Address		
Phone		
Email		
In what capacity does this person know you?		

Name of referee 2

Address		
Phone		
Email		
In what capacity does this person know you?		

All applicants will be subject to a full DBS check	

Name		

Signature		

N.B. the acceptance of membership of an organisation and individuals will be at the discretion of the Board of Directors and upon payment of £1.00 membership fee.	

Declaration

I declare that (please tick each item):

                    I am willing to act as a charity trustee of the above-named organisation

 		

☐

I understand the organisation’s purpose and rules set out in its governing document

☐

I am aware of my duties and responsibilities as a charity trustee in terms of section 66 of the charities and trustee investment (Scotland) act 2005 (“the 2005 act”)

☐

I am not disqualified from being a charity trustee in terms of the 2005 act – that is:

•	I am not an undischarged bankrupt
•	I have not granted a protected trust deed (ptd)
•	I do not have an unspent conviction for an offence involving dishonesty
•	I do not have an unspent conviction for an offence under the 2005 act
•	I have not been removed by the court of session under the 2005 act (or earlier legislation) from being a charity trustee or being concerned in the management or control of any charity or body
•	I have not been removed from being a charity trustee by the charity commission or the high court in England due to misconduct or mismanagement
•	I have not entered into an individual voluntary arrangement (iva) to pay off debts with creditors (this only applies to trustees living in England or Wales)
•	I am not disqualified from being a company director

I understand it is an offence under section 26 of the 2005 act to knowingly or recklessly provide false or misleading information

Signature

Date

Equal opportunities monitoring

The data collected in this section will not be available to those involved in the short-listing or interview process. Such information will be held in accordance with the foundation’s privacy policy.

White	
Scottish		
Other British		
Irish		
Any other white background - please tell us about this 		
Mixed	
Mixed - please tell us about this 		
Asian, Asian Scottish, or Asian British	
Indian		
Pakistani		
Bangladeshi		
Chinese		
Other Asian background - please tell us about this 		
Black Scottish, or other black British	
African		
Caribbean		
Other black background - please tell us about this 		
Other ethnic background	
Other ethnic background - please tell us about this 		
I would prefer not to answer this question…	
I would prefer not to answer this question		

Gender	Please put an ‘X’ in the appropriate box:

Male		
Female		
I would prefer not to answer this question		

Age       please put an ‘x’ in the appropriate box	

  We do not ask for specific age data but for monitoring purposes please indicate the grouping that applies to you:

16 – 24		35 – 44		55 – 64		
25 – 34		45 – 54		65+		
I would prefer not to answer this question			

 
Religion/Faith/Belief Please put an ‘X’ in the appropriate box, which best describes your religion, religious denomination, or body, if any, you below to:

None		
Church of Scotland		
Roman Catholic		
Other Christian		
Muslim		
Jewish		
Hindu		
Buddhist		
Sikh		
Other - please tell us about this 		
I would prefer not to answer this question		

	

Disability      do you consider yourself to have a disability

Yes		
No		
I would prefer not to answer this question