Y Lab HARP Nourish (Scale & Sustain) EOI Nov 2020

This should be completed by a lead applicant organisation, on behalf of the partnership. The lead applicant will be the grant recipient if the application is ultimately successful, so will be responsible for distributing monies to other parties, including any artist commissioning. Please complete this form as soon as possible, but no later than 10am on 23 Nov 2020. Your data will be stored in accordance with Nesta's privacy policy: https://www.nesta.org.uk/privacy/

1. Your first name *This question is required.

2. Your last name *This question is required.

3. Your e-mail address *This question is required. This question requires a valid email address.

4. Your telephone number (mobile preferred) *This question is required.

5. Your role title *This question is required.

6. The organisation you are representing in this application *This question is required.

8. Registered charity number (if applicable)

9. Organisation address *This question is required.

Street address *This question is required.

Town / City *This question is required.

Post code *This question is required.

10. Location of the place you would like us to work with in HARP seed (both geographic location and whether this is, say, a ward, hospital, GP practice, a particular community, the online setting, or a part of your system e.g. comms team) - more than one place is fine, too. *This question is required.

11. Who do you want to benefit in this challenge? (e.g. hospital staff in Intensive Care Units, people with a mental health diagnosis, public health for people experiencing racism) and why (up to 150 words) *This question is required.

14. Briefly describe the project you are interested in applying to HARP for - what creative activities it uses and the main aims of the project (up to 200 words) *This question is required.

15. Other than the direct project need, can you tell us a little more about any health system challenges you are looking to address with HARP and how Covid-19 has affected this? (e.g. workforce retention, long term funding, evidence building, advocacy with leaders) (up to 200 words) *This question is required.

16. What are your ambitions for the project during the programme? (2-3 bullet points) *This question is required.

17. Please tell us roughly how much money you might be looking to apply for. This should be up to around £35,000. Please also give a top-level outline of what you anticipate spending this on. *This question is required.

18. Do you have an early idea of your long term funding goal for this project after 2021? (up to 50 words) *This question is required.

19. Please list contact details for all partners you intend to involve in this project. There must be at least one health partner and one arts partner in order for this project to be eligible for consideration.

Health Partner: *This question is required.

First name *This question is required.

Last name *This question is required.

Position / role *This question is required.

Organisation name *This question is required.

E-mail address *This question is required. This question requires a valid email address.

20. Arts Partner: *This question is required.

First name *This question is required.

Last name *This question is required.

Position / role *This question is required.

Organisation name *This question is required.

E-mail address *This question is required. This question requires a valid email address.

21. Partner Three:

First name

Last name

Position / role

Organisation name

E-mail address This question requires a valid email address.

22. Partner Four:

First name

Last name

Position / role

Organisation name

E-mail address This question requires a valid email address.

23. Contact for collecting data on impact in your organisation (evaluation manager, researcher, data lead) - ideally this should be a different person from the main contact. *This question is required.

First name *This question is required.

Last name *This question is required.

Position / role *This question is required.

Organisation name *This question is required.

E-mail address *This question is required. This question requires a valid email address.

24. Contact for communications and marketing on this project- ideally this should be a different person from the main contact. *This question is required.

First name *This question is required.

Last name *This question is required.

Position / role *This question is required.

Organisation name *This question is required.

E-mail address *This question is required. This question requires a valid email address.

25. Is there any other information you'd like to share with us at this time?

Y Lab HARP Nourish (Scale & Sustain) EOI Nov 2020

HARP Nourish 2020 - Expression of Interest Form