artscouncil-ni.orgartscouncil-ni.org/.../aaop_form.docx · web viewa copy of our most recent...

Arts & Older People Application Form June 2015

Arts and Older People Grants Programme 2013 -2016

Application Form

THIS FORM SHOULD BE USED IF YOU ARE SEEKING SUPPORT FOR ONE SPECIFIC PROJECT BETWEEN £1,000 AND £10,000.

Application round opens Deadline for receipt of applications

Decision due

24 June 2015 Thursday 20 August 2015 at 4pm

End of October 2015

We aim to inform you of our final decision within 3 months of the closing date. Your project should commence after 1st November 2015.

Copies of the Guidance Notes, Application Form and Scoring Criteria are available to download at www.artscouncil-ni.org.

Please send completed application forms to:

Arts and Older People ProgrammeArts Council of Northern Ireland MacNeice House77 Malone RoadBELFASTBT9 6AQ

If you need assistance to complete the application form, please contact Lorraine Calderwood, the Arts & Older People Community Development Officer on 028 90385200 or [email protected].

http://www.artscouncil-ni.org/


ARTS & OLDER PEOPLE PROGRAMME

Section 1 Contact DetailsSection 2 Project Description, Aims and ObjectivesSection 3 MoneySection 4 Publicity, Openness, and AccountabilitySection 5 Equality of Opportunity and Good Relations Commitment, Children and Vulnerable Adults Protection Policy StatementSection 6 Equality Monitoring Section 7 Enclosures & ChecklistSection 8 Applicant’s statement

Applicants are advised to read the full guidelines before completing any section of the application form. All questions must be answered, even if it is to state that the question is not applicable (N/A) to your particular project giving a short explanation.

All applications must be received by 4.00 pm on the closing date. The Arts Council will not accept any application which is received after the closing time/date. It is your responsibility to ensure that your application is received in time. Please note that proof of postage is not proof of delivery.

The information provided on the application form may be shared with other Lottery Distributors to enable them to detect fraudulent applications. It may also be used by the Department for Culture, Media and Sport and the Department of Culture, Arts and Leisure.

This Application Form and the relevant Guidance Notes are available on request in large print format, disk and audio tape and also on the Arts Council’s website:http://www.artscouncil-ni.org

A) On line application If you choose to submit on-line you must submit ALL documents and the application form at the same time. Online applications may be edited, saved and returned to up to the closing date. Please ensure that you leave sufficient time to upload all documents to the system as there can be long delays as the closing deadline approaches and the system will shut down at 4.00 pm on the closing date. If your complete application is not uploaded when the system closes your application will not be accepted. Please note that your on-line application will require you to scan and upload an electronic signature page, signed by your Chair or Committee member.

B) Hard Copy application If you choose to submit in hard copy, you must submit ALL documents and the application form at the same time.

The application form may be typewritten or handwritten. If handwritten, it should be completed in block capitals and black ink, using additional paper where required. The form


may also be completed by reproducing the questions, with answers, on your own word processing system.

Part or all of the information you provide will be held on computer. This information will be used for the administration of applications and grants and for producing statistics. Copies of this information will be provided, when necessary, to individuals and organisations who may need to be consulted when assessing applications and monitoring grants.Please complete and return the application form and enclosures. The form must have an original signature.

Completed forms should be sent to:Arts Council of Northern Ireland, Arts Development Department, MacNeice House, 77 Malone Road, BELFAST BT9 6AQ

NOTE: Applications submitted by fax, disk or e-mail cannot be accepted as we require original signatures on at least one copy of the form.

REMEMBER TO KEEP A COPY OF THE COMPLETED FORM AND ENCLOSURES FOR YOUR RECORDS


SECTION 1 – CONTACT DETAILS

Name of Group _________________________________________________________(this should be the same as the name on your constitution)

Postal Address of Group __________________________________________________

_______________________________________________________________________

City/Town _____________________ Post Code __________________

Tel: ___________________________ Fax: _______________________

E-mail Address ___________________________________

Website Address __________________________________

District Council area in which your organisation meets __________________________

Ward area ______________________________________________________________

Name of Contact Person (the person we will communicate with and who is able to answer questions on behalf of your organisation))

Title ____ First Name ________________ Surname __________________________

Contact Person’s Address: _________________________________________________

________________________________________________________________________

City/Town _____________________ Post Code __________________

Daytime Tel: ______________________ Fax: ______________________

E-mail Address ___________________________________

What type of group are you? (most community groups are unincorporated club or association).

Unincorporated club or associationCompany limited by guaranteeCompany limited by sharesRecognised charityTrustOther: Please specify


In what year was your organisation started?

What are the main activities of your group/the main purpose of your organisation? (In no more than 50 words)

Recognised Charity Number (if applicable) __________________________________________

VAT Registration Number (if applicable) ___________________________________________

How many permanent paid staff (if any) work for your organisation?_____________________

How many volunteers including committee or board members are involved in your organisation?

______________________

Is your organisation:

(a) Registered with Access NI? Yes No

If Yes, please give

Date of RegistrationAccess NI Registration NumberName of Lead Signatory for Registration

OR

(b) Registered with an umbrella body in order to obtain Access NI checks?

Yes No

If Yes, please give name of umbrella body.


If The Organisation is not registered in either case above, please provide a statement detailing why this is the case.


SECTION 2 - PROJECT DESCRIPTION

Title of Project ______________________________________________________

Please list the main aims of your project, what actions you will take to achieve them and what resources you will need, these sections should be completed in no less than 50 and no more than 400 words. Any text over the 400 words will not be taken into consideration. In addition you must also attach a more detailed description of your project, please see FAQs number 15 for details of what this description should cover.

Please describe your project.

What work/consultation have you undertaken up to now on this project?

How will you do it? (actions)


What will you need to do it? (resources)(You must submit CVs for any artists/arts facilitators you intend to employ as part of the Process, if known)

When will your project start? __________________________________________________

How long will your project last? ________________________________________________

How many artists do you estimate will be involved in your project? ____________________

How will you measure the success of the project and the achievement of its aims and objectives? (E.g. number of people participating, new artforms introduced, creation of original work)


How does your project meet the criteria listed in the guidance notes on pages 7 & 8. Answer each criterion in no less than 50 and no more than 300 words. Any text over the 300 words will not be taken into consideration.

Criterion 1: Strategic Impact including how you meet the Themes of the programme.

Criterion 2: Partnership Working

Criterion 3: Quality of Artistic Activity Planned / Experience of Artists working with the target group


Criterion 4: Organisational and Project Viability


SECTION 3 - MONEY

How much will your project cost and how much do you need from us? For any item or activity over £1,000 you must provide a breakdown along with your more detailed project description. You must write in this table – do not write “see attached sheet”.

Item or Activity Total cost Requested amount

Artist Costs (inc travel) £ £Equipment / materials £ £Publicity / marketing £ £Community consultation costs £ £Co-ordination costs £ £Equipment hire £ £Venue Hire £ £Essential travel within N. Ireland £ £Research and Development £ £Publicity / distribution costs £ £Volunteer expenses £ £Premium Payment £ £Other £ £Totals £ £Income Generated £Grand Total (Total – Income) £

If the total cost is more than you have requested from us, please tell us where the rest of the funding will come from: If awaiting a funding decision from another funding body please provide details of when the funding decision is expected.

In Cash

In Kind

Please tell us if your project will generate income. (For example through box office sales or publications.) All income generated through the project must be declared and off set against the total cost of the project.

Income Generation


Please give us your group’s bank account details. Please double check that they are correct as if you are successful, funds will be paid directly into this account. The account name MUST be the same as the name stated on your constitution.

Account NameBank or Building Society NameBank of Building Society Address

Sort CodeAccount NumberRoll Number (for Building Society accounts)

How many people have to sign each cheque or withdrawal from this account? _____(we will pay awards only into an account that requires at least two unrelated people to sign each cheque or withdrawal from the account)Please list all cheque/withdrawal signatories.

Name Position in Group

Please give details of your most recent annual accounts.

Accounts for year ending: D M YTotal (gross) incomeTotal expenditureProfit or loss for yearSavings (reserves, cash or investments)


SECTION 4 - PUBLICITY, OPENNESS AND ACCOUNTABILITY

PublicityFull listings of all the grants we award will be published. You will be required to acknowledge this funding in all your publicity, please see our acknowledgment guide. Failure to credit this award as stated in our acknowledgment guide will affect payment of your grant.

Images submitted in support of your application may be stored electronically by us. If we later seek to use these for publicity purposes, we will contact you in order to obtain permission to do so.

1. Openness and accountability Under the Freedom of Information Act 2000 any information held by us (which will include your application) is potentially accessible by the public.

Information supplied by you will be held in manual files. It will then be summarised and details transferred to a computer-based grants management system. Reports from the information you supply and from comments made on your application by external assessors and staff members are likely to be held on both manual and computer-based systems. The information you supply will be made available to those assessing any other grant applications you make.

By submitting your application you waive any right to raise any type of proceedings against the Arts Council of Northern Ireland as a consequence of, or in contemplation of, any disclosure of the contents of your application in response to an information request made under the Freedom of Information Act 2000.

2. Data protection

Data held on our grants management system is used for of the following purposes; statistical reporting, application assessing, accounting purposes and for contacting you. The details of your grant will be public information (see Openness and Accountability). However, your personal details will be held within our grants management system and our paper files, and accessed only by our staff; appointed auditors and individuals or organisations who may help us assess or monitor grants. You have a right under the Data Protection Act 1998 to access the data held on you by Re-imaging Communities. We might also send you further information about other programmes.

We view your signature on your application form as acceptance of the use of your data as outlined above.

Please note that if you deliberately give any false or misleading information, we will withdraw your application or, if a grant has already been awarded, ask you to pay back any money we have given you. This will also have implications for any future applications you may submit.


SECTION 5 - EQUALITY OF OPPORTUNITY and GOOD RELATIONS COMMITMENT

It is a requirement of the funding conditions under the Arts & Older People Programme that your organisation commits to equality of opportunity and good relations duty. Therefore, this Statement MUST be adopted by your organisation.

The Arts Council of Northern Ireland has a statutory duty under the Northern Ireland Act 1998, in carrying out its functions to have due regard to the need to promote equality of opportunity between:

Persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation;

Men and women generally; Persons with a disability and persons without; and Persons with dependants and persons without.

In addition, without prejudice to its obligations above, the Arts Council shall, in carrying out its functions relating to Northern Ireland, have regard to the desirability of promoting good relations between persons of different religious belief, political opinion or racial group.

We (name of organisation) ………………………………………………………….recognise these obligations and undertake not to act in any way, which would contravene the Arts Council’s statutory duty. We confirm our commitment to the principles of affording equality of opportunity in all aspects of our organisation’s activities, in particular with regard to access and participation in these activities.

It is also our intention to ensure equal opportunity for all job applicants and employees and to eradicate direct or indirect discrimination.

It is also our intention to have regard to the desirability of promoting good relations between: Persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation; Men and women generally; Persons with a disability and persons without; and Persons with dependants and persons without.

This Equality of Opportunity and Good Relations Commitment was formally adopted by us on

(insert date) ………………………………………………………………………………...

Authorised Signature ………………………………………………… Date ……………

Position in Organisation ……………………………………………………………………


SECTION 5 (cont) - CHILDREN AND VULNERABLE ADULTS PROTECTION POLICY STATEMENT

Due to changes in Government legislation, it is a requirement of our funding that all organisations which come into contact with children, young people and vulnerable adults, either directly through its programmes or indirectly through its services, must commit to a Child Protection /Safeguarding Policy. The document must have been agreed by your organisation and should be signed and dated. If you are unable to tick all the Safeguarding Checklist boxes as “yes” at the time of submitting the application, you must take steps to address all the issues prior to the drawdown of any funds. Government has issued guidance that no funds should be paid across to organisations until they are able to sign up completely to the safeguarding checklist.

We (name of organisation) ……………………………………………………………….are committed to practice which protects children from harm. Staff, volunteers and artists in this organisation accept and recognise their responsibilities under the Children (NI) Order 1995, about safeguarding children, and will endeavour to carry these out by:

having an awareness of the issues which cause children harm; adopting child protection guidelines for staff, leaders, volunteers and artists; providing information about child protection and good practice to children, parents,

staff, volunteers and artists; sharing information about concerns with children, parents and others who need to

know; following carefully the procedures and recruitment and selection of helpers (staff,

volunteers, artists) and the management of the group; undertaking appropriate training; keeping child protection policies under regular review; and providing information as required to management committees/ funders

This Child Protection Policy statement was formally adopted by us on

(insert date) ………………………………………………………………………………...

Authorised Signature ………………………………………………… Date ……………

Position in Organisation ……………………………………………………………………


Safeguarding ChecklistOrganisation Name:

Question Types of evidence Yes No CommentsDoes your organisation have a safeguarding statement agreed by senior management?

Copy of statementStatement promoted to stakeholdersPromoted on web site

Does your organisation have written procedures for recruitment and selection of staff and volunteers?

Written job descriptionWritten application form to include request for references and self declaration.Record of interviewFollow-up on written references

Are all staff and volunteer appointments subject to the appropriate safeguarding checks and these are properly recorded?

Access NI reference check recordedWritten list of roles that are “regulated” within the organisationProof of ID request

Does your organisation provide Safeguarding training for Designated Officer, staff and volunteers?

Written list of information provided to staff on induction.Copy of letters/memos/certificate outlining safeguarding training provided to staff.Data-base of those trainedLearning outcomes from safeguarding training.Name of designated Safeguarding Officer (Please provide name of body in comments)

Does your organisation regularly re-evaluate and update your safeguarding training and education?

Copy of letters/memos/certificate outlining Safeguarding training provided to staff.

Does your organisation have written procedures for reporting child protection concerns, disclosures and allegations?

Written procedures for reporting concerns to Designated Officer and statutory servicesPro formas/written guidance.

Are the procedures for reporting concerns communicated to staff and volunteers?

Confirmation from staff (especially recently recruited) that they have received safeguarding training and written reporting procedures

Does your organisation have an open complaints process that includes guidelines on a disciplinary process?

Copy of complaints, disciplinary and appeals process.Evidence of how this is communicated to stakeholders

Does your organisation have written procedures for Designated Officers?

Written documents stating the name and up to date contact details of Designated Officers.(Please name Designated Safeguarding Officer(s)in comments)


Are the contact details of Designated Officers communicated to staff/volunteers?

Written evidence to support that staff, members and volunteers are aware of who to contact and how.Confirmation from staff/volunteers

Do you have a written Code of Behaviour?

Written Code of BehaviourEvidence this is communicated to all stakeholders

Do you have a written Safeguarding policy and procedures, endorsed and approved by Management Board?

Written Policy Statement and associated proceduresPlease advise when last reviewed and updated.

Do you communicate your Safeguarding policy statement to staff/volunteers/children/young people/ vulnerable adults and parents?

Confirmation from staff/ volunteers/ children/ vulnerable adults and parents that they received a copy or know where to access the policy

SAFEGUARDING CHECKLIST COMPLETED BY:

Authorised Signature …………………………………… Date ……………………………

Position in Organisation ……….……………………………………………………………….

Please refer to the Arts Council’s Child Protection Best Practice Guidelines For Arts Organisations to ensure your own guidelines and policy represent good practice in relation to working with children.www.artscouncil-ni.org/images/uploads/publications-documents/Child_protection_guidelines.pdf


SECTION 6 - EQUALITY MONITORING

(The information provided in this section will not form part of any assessment process, but will be used by the Arts Council solely for statistical gathering purposes.)

A. TELL US ABOUT THE PEOPLE WHO WILL BENEFIT FROM THE WORK YOU WILL UNDERTAKE WITH THIS GRANT .

For each question the main group to benefit, means: “comprises more than 60% of that group”

1. Persons with a DisabilityThe Disability Discrimination Act defines a disabled person as someone with a disability or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities.

The main group to benefit:Please () one box only

People with a DisabilityPeople without a DisabilityPeople with a Disability and People without a Disability(where neither community is over 60%)We are unable to specify which group will mainly benefit

2. Men and Women

The main group to benefit will be:Please () one box only

Women (including girls)Men (including boys)Transgendered peopleBoth women and men(where neither community is over 60%)We are unable to specify which group will mainly

benefit

2. Persons with DependantsWe understand people with dependants to be those with personal responsibility for the care of a child, the care of a person with an incapacitating disability and/or the care of a dependant elderly person.

The main group to benefit will be: Please () one box only

People with dependantsPeople without dependantsPeople with dependants and people without

dependants(where neither community is over 60%)We are unable to specify which group will mainly

benefit


3. Religious Belief

The main group to benefit will be: Please () one box onlyProtestantCatholicBoth Protestant and Catholic communities(where neither community is over 60%)BuddhistHinduIslam / MuslimJewishSikhOther Religious BeliefWe are unable to specify which group will mainly

benefit

4. Political Opinion

The main group to benefit will be: Please () one box onlyNationalist generallyUnionist generallyOtherWe are unable to specify which group will mainly

benefit

5. Racial Group

The main group to benefit will be: Please () one box onlyBlack AfricanBlack CaribbeanOther Black BackgroundIndianPakistaniBangladeshiOther Asian BackgroundChineseMixed ethnic groupIrish TravellerWhiteOther (Please specify)We are unable to specify which group will mainly

benefit


7. Marital Status

The main group to benefit will be: Please () one box onlyMarriedUnmarriedDivorcedSeparatedWidowedWe are unable to specify which group will mainly

benefit

8. Sexual Orientation

The main group to benefit will be: Please () one box onlyGay peopleLesbian peopleHeterosexual peopleBisexual peopleWe are unable to specify which group will mainly

benefit

9. Age

The main group to benefit will be: Please () one box onlyUnder 16Aged 16 – 25Aged 26 – 50Aged 50 – 65Over 65We are unable to specify which group will mainly

benefit


TELL US ABOUT THE MAKE UP OF YOUR BOARD/MANAGEMENT COMMITTEE

For each question “mainly comprise”, means more than 60%

10. Persons with a Disability The Disability Discrimination Act defines a disabled person as someone with a disability or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities

Does the Board/Management committee mainly comprise: Please () one box onlyPeople with a DisabilityPeople without a DisabilityPeople with a Disability and People without a

Disability(where neither community is over 60%)

11. Men and Women

Does the Board/Management committee mainly comprise: Please () one box onlyWomen (including girls)Men (including boys)Transgendered peopleBoth women and men(where neither community is over 60%)

12. Persons with Dependants We understand people with dependants to be those with personal responsibility for the care of a child, the care of a person with an incapacitating disability and/or the care of a dependant elderly person.

Does the Board/Management committee mainly comprise: Please () one box onlyPeople with dependantsPeople without dependantsPeople with dependants and people without

dependants(where neither community is over 60%)We are unable to specify


13. Religious Belief

Does the Board/Management committee mainly comprise: Please () one box onlyProtestantCatholicBoth Protestant and Catholic communities(where neither community is over 60%)BuddhistHinduIslam / MuslimJewishSikhOther Religious BeliefWe are unable to specify

14. Political Opinion

Does the Board/Management committee mainly comprise: Please () one box onlyNationalist generallyUnionist generallyOtherWe are unable to specify

15. Racial Group

Does the Board/Management committee mainly comprise: Please ()one box onlyBlack AfricanBlack CaribbeanOther Black BackgroundIndianPakistaniBangladeshiOther Asian BackgroundChineseMixed ethnic groupIrish TravellerWhiteOther (Please specify)We are unable to specify


16. Marital Status

Does the Board/Management committee mainly comprise: Please () one box onlyMarriedUnmarriedDivorcedSeparatedWidowedWe are unable to specify

17. Sexual Orientation

Does the Board/Management committee mainly comprise: Please () one box onlyGay peopleLesbian peopleHeterosexual peopleBisexual peopleWe are unable to specify

18. Age

Does the Board/Management committee mainly comprise: Please () one box onlyUnder 16Aged 16 – 25Aged 26 – 50Aged 50 – 65Over 65We are unable to specify


SECTION 7 – ENCLOSURES & CHECKLISTI have completed the form

I have answered all the questions on the formI am the main contact named in question 1

Organisations currently in receipt of a 2015/2016 Annual Funding Programme award do not have to submit a constitution or accounts.Statutory Bodies do not have to submit a copy of their statutory instrument.

I have enclosed the following ESSENTIAL documents

A copy of our constitution or set of rules (dated and signed as adopted)A copy of our Equal Opportunities Policy (signed and dated as adopted)A copy of our most recent annual accounts, dated and signed as approved by a senior member of our management committee, These should be prior to December 2014. If this is not available please provide the most recent set of annual accounts (signed and dated as adopted) and in addition, for the period after December 2014, most recent set of management accounts (signed and dated as adopted).OR(for newly established groups only) an estimate of our income and expenditure for the first year, dated and signed as approvedOR(for statutory bodies) the annual income and expenditure accountThree months’ worth of original, consecutive bank statements, the most recent of which is not more than 3 months oldORphotocopies of the pages of our building society passbook that show the account name and number, as well as the last three months’ transactions, each page stamped and signed by the building society as “true copies of the original’ORthe last three months’ transactions of our Internet Account signed and dated by our TreasurerOR(for new groups which do not have three months’ worth of bank statements), all the statements we haveDetailed project description (see guidance notes FAQ 15. for what this should include)Detailed income and expenditure budget for this project. You MUST attach a detailed breakdown of the expenditure and income you expect to incur. Provide as detailed a budget as possible, including a breakdown of any budget line over £1,000.Arts Organisations and Local Authorities must provide details of previous experience of working with older people

If you have ticked the boxes above, your application should now be complete. If it is not, we will have to return your application to you and this will affect the turnaround time of your application … so double check just to be sure. You may also have some of the documents below which you wish to send.


I have enclosed the following other documents (if available): Please tick

CVs of artists, arts organisations and personnel who will be involved in the projectQuotations or notes used to work out the costsOther document: please specify

Please remember to keep a copy of this application for your own use.

Send the application and the documents to:Arts & Older People ProgrammeArts Council of Northern IrelandMacNeice House77 Malone RoadBELFAST BT9 6AQ

If you need further information about completion of the form contact us by telephone on 028 9038 5200


SECTION 8 - APPLICANT’S STATEMENT

Please complete the section below to authorise your application.

The Chair of the organisation or a committee member must sign this declaration and the most senior employee or one other committee member must witness it. Please note that any misleading statements (whether deliberate or accidental) given at any stage during the application process may render the application invalid. The Arts Council will take steps to recover all monies in respect of a grant where it discovers evidence that false statements have been supplied or where a project is not complete or no acceptable reason for non-compliance is forthcoming.

I confirm that I am authorised to sign this declaration on behalf of _______________________________________________ (organisation) and that, to the best of my knowledge and belief, all the information supplied on this form, and any accompanying documents is true and accurate. I undertake to immediately and fully inform the Arts Council of Northern Ireland if any changes in circumstances require the application to be amended.

I confirm that the person named at Section 1 is authorised to act as the contact for the organisation in all matters relating to this application.

Name (Chair or Committee member): __________________________________

Designation: ____________________________________

Signature: ______________________________________

Date: __________________________________________

Name (senior employee or second Committee member)

________________________________________________

Designation: _____________________________________

Signature: _______________________________________

Date: ___________________________________________

artscouncil-ni.orgartscouncil-ni.org/.../aaop_form.docx · web viewa copy of our most recent...

Documents