European Regional Development Fund2014-2020 Programme

SPEED Application FormPersonal Details

Title Surname First name(s)

Address

Contact detailsMobile number

Email address

Other detailsDate of birth

Nationality

Current statusPlease confirm if you are a current student ☐ or graduate ☐ if so please provide your year of graduation ___________

Student Graduate Business Professional/ Entrepreneur

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If you are a current student please complete the details below

SPEED is an element of the Enterprise Action Project part funded by the European Regional Development Fund and delivered by the University of Wolverhampton.

European Regional Development Fund2014-2020 Programme

Faculty Year of study

Course title Student number

How did you hear about the SPEED project?

Website ☐ Email ☐Word of mouth ☐ Member of staff ☐Internet search ☐ Banner/poster ☐Other (please specify) ☐The Business IdeaPlease provide a summary of your business idea/product or service (500 characters maximum)

I confirm that i have not yet started to trade (please tick) ☐I confirm i am prepared to register my business whilst on the SPEED project (please tick) ☐

What is your motivation for applying to the SPEED project?

SPEED is an element of the Enterprise Action Project part funded by the European Regional Development Fund and delivered by the University of Wolverhampton.

European Regional Development Fund2014-2020 Programme

What do you think the main challenges will be if you are accepted onto the SPEED project?

What are your expectations of the SPEED project in terms of support, time and benefits to you?

Data ProtectionThe information that you provide on this application form will be available to: university project and finance staff involved in the management of SPEED; the regional agency, Department for Communities and Local Government (DCLG)You agree that your personal information may be used for evaluation purposes and to participate in any evaluation exercise carried out by the funding agency or an external consultant.

We may take pictures/videos of you and your company as well as quotes or case studies about your experience on the SPEED project. I give my consent for the SPEED project to use these (please tick).

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Please tick here to confirm that you have read and understood the above conditions.This is a fundamental requirement for any person wishing to participate in the SPEED project.

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SPEED is an element of the Enterprise Action Project part funded by the European Regional Development Fund and delivered by the University of Wolverhampton.

European Regional Development Fund2014-2020 Programme

Equality & Diversity Monitoring InformationThe SPEED project attempts to provide equality of opportunity throughout its selection process. In addition we are required to provide statistical information about our beneficiaries to the funding body, the European Regional Development Fund (ERDF) or their agent, DCLG. In order to comply with this requirement and to be able to monitor the effectiveness of our diversity policies we ask you to complete the following information. This is voluntary and the information you provide will be treated in total confidence and will have no effect on your application. Thank you for your co-operation.

Ethnicity information

☐ Asian – Bangladeshi ☐ mixed – white & black African ☐ black – African

☐ Asian - Indian ☐ mixed – white & black Caribbean ☐ black – Caribbean

☐ Asian – Pakistani ☐ other – Chinese ☐ black - other

☐ Asian – other background ☐ White -British ☐ Mixed – other

☐ mixed – white & Asian ☐ White - Irish ☐ White - other

☐ any other ethnic group ☐ Prefer not to say

Disability information

☐ Yes ☐ No ☐ Prefer not to say

Gender information

☐ Male ☐ Female ☐ Prefer not to say

Age

☐ 16-24 ☐ 40-44 ☐ 60-64

☐ 25-29 ☐ 45-49 ☐ 65+

☐ 30-34 ☐ 50-54 ☐ Prefer not to say

SPEED is an element of the Enterprise Action Project part funded by the European Regional Development Fund and delivered by the University of Wolverhampton.

European Regional Development Fund2014-2020 Programme

☐ 35-39 ☐ 55-59

Signed Date

Please sign this form and return to:

Angena Patel, University of Wolverhampton, PA104, Technology Centre, Glaisher Drive, Wolverhampton, WV10

9RU

Please note that all applications must have original signatures and posted to the above address. Electronic copies are not admissible.

SPEED is an element of the Enterprise Action Project part funded by the European Regional Development Fund and delivered by the University of Wolverhampton.