B:CAN Application Form Complete the form below to applyThank you for your interest in joining the B:CAN network. Please review the membership criteria carefully here and complete all sections of this form as fully and accurately as possible. Providing detailed information will help us process your application more efficiently. As part of this application, you are required to declare your organisation’s annual turnover for the past three financial years. If you do not meet the eligibility criteria for the selected membership category, you will be notified during completion of the form and advised on next steps. All information submitted will be treated in confidence and used solely for B:CAN membership administration and strategic development purposes.Membership TypePlease refer to the B:CAN Membership criteria by clicking hereMembership Type(Required) Member Affiliate Partner Do you sign up to the B:CAN Principles Paper?You can download a copy of the B:CAN Principals by clicking here. Yes No Is your organisation based in Birmingham and has a neighbourhood focus? Yes No This is a mandatory criterionUnfortunately you have not met the criteria for joining B:CAN – please contact michelle.webb@B:CAN.co.uk if you have further questions. Organisation DetailsName of Organisation(Required)Address(Required) Street Address Address Line 2 City Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Website Social mediaClick the + icon to add more. Add RemoveContact DetailsName of Contact (CEO or equivalent)(Required) First Last Contact Telephone NumberEmail Address(Required) Which Birmingham Wards do you provide the majority of your services in? About Your Organisation4. What year were you formally incorporated?(Required)Please note: to join B:CAN as a full member, your organisation must have been set up before 2019. If your organisation was set up after 2019, you can still complete this form to apply as an Affiliate. MM slash DD slash YYYY What is your organisations legal status?(Required) Charity Community Benefit Society Charitable Incorporated Organisation Community Interest Company None of the above This is a mandatory criterionUnfortunately you have not met the criteria for joining B:CAN as a Member, continue completing the form if you wish to apply as an Affiliate.This field is hidden when viewing the formRegistration NumberCharity Registration NumberCompanies Registration NumberFinancial InformationWas your annual turnover over £100,000 in three of the previous five years?(Required) Yes No This is a mandatory criterionUnfortunately you have not met the criteria for joining B:CAN as a Member, continue completing the form if you wish to apply as an Affiliate.This field is hidden when viewing the formYearly Turnover2021(Required)2022(Required)2023(Required)2024(Required)2025(Required)Reserves for Last Financial Year(Required)Organisation AssetsDo you have a community hub or asset accessible to local residents?(Required) Yes No This is a mandatory criterionUnfortunately you have not met the criteria for joining B:CAN as a Member, continue completing the form if you wish to apply as an Affiliate.This field is hidden when viewing the formCommunity Assest DetailsIs the address the same as registered address above? Yes No Address Street Address Address Line 2 City Post Code Do you have more than one hub or asset?(Required) Yes No How many buildings or facilities do you have?This is a mandatory criterionUnfortunately, on this occasion you have not met the criteria to become a B:CAN Affiliate. If you would like to discuss this please contact michelle.webb@bcan.co.uk if you have further questions or would like to discuss partnership opportunities. GovernanceHow do local residents influence your decision making, work and priorities? (e.g. Board, Committee level etc)(Required)Staffing and VolunteersNumber of Staff – Full-Time(Required)Number of Staff – Part-Time(Required)Number of Volunteers(Required)Main Activities / Services ProvidedTick all boxes that best describe your organisation’s main activities/services provided(Required) Support and Advocacy – helping individuals navigate systems and understand their rights Information and Guidance – providing health education, disease prevention information, and resources to access services Energy Advice – guidance on reducing energy bills, improving energy efficiency, and accessing financial support/grants Sports Clubs and physical activities – using sport to engage young people and others, fostering teamwork and promoting inclusion Counselling and emotional support – one-to-one counselling, support groups, and helplines Practical Support – assisting with daily tasks like shopping, cleaning, and home visits for the elderly or disabled Social Care Services – providing care for vulnerable individuals to maintain their independence Employment Support – helping people find and retain jobs through training and job placement services Community Transport – transportation services for those who cannot access public transport Homelessness Support – providing temporary accommodation and support for homeless individuals Domestic Violence and Abuse Services – offering support and safe spaces for victims of Domestic Violence Education and Training – providing educational programs and skills training ESOL classes – helping non-native speakers improve their English proficiency Social Housing Provider – delivering affordable, secure housing Other If ‘Other’, please specifyAccreditations HeldPlease tick all current Accreditations held by your Organisation Matrix Standard – quality framework for information, advice, and guidance services Investing in Volunteers – UK quality standard for volunteer management Fundraising Regulator Registration – ethical and transparent fundraising practices Investors in People (IIP) – enhancing employee engagement, development, and wellbeing Disability Confident Employer Mark – commitment to inclusive hiring and supporting disabled employees ISO 9001 Quality Management – ensuring quality, transparency, and efficiency ISO 14001 Environmental Management – commitment to environmental best practices CQC Registration – meeting essential standards of Health and Social Care quality and safety Other 22. If ‘Other’, please specifyDeclarationBy submitting this form, I confirm that the information provided is accurate to the best of my knowledge. I understand this information will be used by BCAN for Membership Administration and Strategic Development in accordance with Data Protection Regulations.Name(Required) First Last Date(Required) MM slash DD slash YYYY
