Blackbird Environmental Fund - Application Form

1 About Your School

School Name: *

School Address: *

School Postcode: *

School City: *

Name of Head teacher: *

Name of school employee making the application: *

Role in school: *

Contact email address: *

Contact phone number: *

Name of business manager: *

Business manager email address: *

Number of children on roll: *

Percentage of pupils who qualify for Pupil Premium: *

Value:

LEA or Academy school? *

LEA

Academy school

Please state name of the MAT Group if appropriate:

2 About The Project

Project title and outline: *

Sustainability: *

Community benefits: *

Recent Environmental Projects or Activity: *

Estimate of costs: *

Pupil involvement: *

3 Confirmations

Confirm whether you have all the necessary approvals to allow the project to proceed. For example, the backing of Senior Leadership and Governors, the allocation of space within the school grounds and the labour required for installation. *

Yes

Confirm that you will be prepared to allow limited and accompanied access to school grounds from Blackbird representatives for support as required. *

Yes

Confirm that within 6 months of project completion that you will submit a brief written resume of the project and its impact. *

Yes

Confirm your willingness to attend a SEEN meeting to share your experiences with other professionals. *

Yes

Other information:

Name of lead school Applicant:
Applicant Signature:

Date:

Name of school Headteacher:
Headteacher Signature:

Date:

Application Form

Thank you for your submission we will endeavour to respond within 3 days.

1 About Your School

2 About The Project

3 Confirmations