Payroll Giving Centre - Making a difference together

Payroll Giving Quality Mark and Award Application

Organisation Details

Name of Organisation

Address Line 1

Address Line 2

Town

City

County

Postcode

Name of Payroll Giving Agency

Number of sites/branches (see Notes)

Number of employees in organisation
(including those working part-time)

Phone number

Organisation Sector

Organisation Sector - more information

Contact Details
In completing these you are giving us your permission to contact you about this

Title

First name

Surname

Job title

Email address

Phone number (direct line)

Please contact me by:

Email Phone

Your Payroll Giving Scheme

When did you set up your Payroll Giving scheme?

How many employees donate through your scheme?

Please tick to indicate the relevant Quality Mark or Award appropriate to the take-up level (% of participating employees) within your organisation:

The Payroll Giving Quality Mark - less than 1% take-up

Bronze Award - between than 1% and 4% take-up

Silver Award - between 5% and 9% take-up

Gold Award - 10% or more take-up plus one of the three following criteria:

	Do you pay the Payroll Giving Agency charge?
	Do you donate any matched funding?
	Have you carried out an active promotion this year? *
	* An active promotion needs to involve at least three of the following communication tools: presentations or talks with employees leaflets and desk drops use of intranet posters on noticeboards in-house magazine through induction materials insert into pay packet

Who promotes Payroll Giving within your organisation? (please supply details of all that apply)

A member of staff

A Professional Fundraising Organisation

A charity representative

A volunteer

A retired member of staff

Other

How will you promote the scheme to your employees? (please select all the methods you will use)

Presentations or talks with employees

Leaflets and desk-drops

Use of intranet

In-house magazine

Posters on noticeboards

Through induction materials

Insert into pay packet

Other - please specify

How often do you promote the scheme to employees?

Which of the following promotion tools would be helpful to you?

A toolkit giving case studies and examples of effective promotions

Sample literature for you to use on your notice board, posters, leaflets, etc.

Information to include with your induction packs

Contact with your Payroll Giving Agency to discuss options

Contact with a Professional Fundraising Organisation to discuss options

Contact with a local charity or charity consortia to discuss options

Notes

Once this form has been completed and submitted we will contact your Payroll Giving Agency, and your Payroll Giving Quality Mark and/or Award will be issued accordingly by your Payroll Giving Agency. The information you provide on this form will only be used in respect of the Payroll Giving Quality Mark and Awards scheme.

If you are applying in respect of more than one organisation, please complete a separate application for each. You should also supply a list of branches, and the relevant trading titles. Should you be eligible for an Award the information provided by you will be re-assessed each year to determine whether your take-up level has varied. This will determine the appropriate Award for you in the following year.

The allocation of a Gold Award is at the discretion of your Payroll Giving Agency.