Southall Community Alliance Membership Application Form

Organisation Name *

Address *

Telephone *

Mobile *

Email *

Name of Contact *

Position in Organisation *

Organisation Status *

• Charitable Company
• Community Interest Company (CIC)
• Company Limited by Guarantee
• Unincorporated Association
• Social Enterprise
• Registered Charity
• Charitable Incorporated Organisation (CIO)

Sector *

• Young People
• Arts
• Faith
• Resident
• Environmental
• Statutory
• Service
• Business
• PTA
• Housing
• Employment
• Women
• Disabled

Tick all that apply

Aims and Objectives of Organisation *

Main Activities of Organisation *

Are there any specific needs / issues that you would like SCA to address? *

Please explain how your work benefits people in the Southall area? *

Have you been involved in any activities/projects in Southall? If so, please provide details. *

What is the average gross annual income of your group/organisation?

Main funding sources

• Earned Income (e.g. charges to service users)
• National Lottery
• NHS
• Grant Making Trusts
• Private Donations
• Membership fees

Number of Members

Number of Service Users

GDPR *

• I consent to receive emails about training, events, newsletters etc

Submit

Please email your Constitution, Supporting letter and annual report to hello@southallcommunityalliance.com