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Durban House Community Hub
This form is for potential partners to formally express an interest in occuping space or delivering services in the Durban House Community Hub
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* Indicates required question
Durban house
Name of Organisation
Your answer
Address of organisation
Your answer
Status or organisation
*
Trust
Private Limited Company
Charity
Public Body
Other:
Required
Primary Contact Name
Your answer
Primary Contact Email
Your answer
What space requirement is required for your organisation?
Your answer
Primary Contact Telephone
Your answer
What space do you require
Internal
External
Both
Clear selection
As it is likely that no ‘exclusive possession’ will be given and occupation of an area within the building and externally will be by licence only (eg: there will be no locked rooms), does this present a problem?
Yes
No
Clear selection
What Access arrangements do you feel are necessary ? (tick all those that apply)
Accessible Parking
Building Adjustments
Grab Rails
Loop System
Large Print
Availability of walking aids, wheelchairs or scooters
Adjustable tables
Cues graphic and audible signs
Accessibiity Software
Other:
Precisely to what function and use does your organisation wish to put space utilised by you to?
Your answer
Would this be for the benefit of children or vulnerable adults and if so, which?
Your answer
Due to Safeguarding All children or young people, or vulnerable adults will be on site, how will you ensure that they are safeguarded when utilising facilities such as shared lavatory/cloakroom facilities?
Your answer
Do you have a safeguarding policy?
Yes
No
Developing
Clear selection
What do you perceive the benefits of your use of part of the building and/or site to be for Eastwood?
Your answer
What do you perceive the benefits of your use of part of the building and/or site to be for Wider Area?
Your answer
How would you finance any likely licence fee?
Your answer
If funding is required, is this already applied for? If not, what is the likely time frame to apply for funding?
Your answer
How many personnel would you expect to have on site and at what times and what days or how many days?
Your answer
Would you require car parking?
Yes
No
If yes how many car parking spaces?
1
2
3
4
5
If yes, how many car parking spaces and for precisely whose vehicles?
Your answer
How many day would you operate your services?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Clear selection
Please state briefly how you perceive your organisation benefitting the ‘hub’ and how long you envisage being part of the ‘hub’?
Your answer
Any comments you feel may be useful in determining the layout of uses within the building and site?
Your answer
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