Appendix 1
1. Name and address of the group or organisation making this proposal:
2. Name and status of person responsible for preparing and submitting this proposal
3. Contact details of person responsible for this proposal
Office telephone no:
Mobile phone number:
E-mail Address
4. Background information on your organisation / project sponsor:
5. Date your organisation/project established:
6. Please list below the main services / activities provided by your organisation;
7. List the main achievements of the Organisation:
8. Legal status of organisation / group:
9. Company registration number:
10. Expenditure in last financial year: Year: Expenditure:
11, List the main sources of income of your group/organisation;
Department of Employment Affairs and Social Protection
An Roinn Gnóthai Fostaiochta agus Coimirce Sóisialaí
Proposal for funding under the Activation & Family Support Programme (AFSP)
Details of project for which you are seeking part-funding under the AFSP
12. What is the name of the project?
13. How was the need for this project identified?
14. Why is the project necessary?
15. What is the main aim of the project?
16. What are its key objectives?
17. Is the programme located in a RAPID or Clár area?
18. If the programme is in a RAPID area, was it initiated at Area Implementation Team (AIT)
level?
Target group /number of beneficiaries
19. Total number of people that will take part in this program: ________
(All participants must be social welfare recipients or their adult dependant and of working
age)
20. How were the participants identified?
21. Was each participant interviewed to determine their suitability for this course? If so, who
interviewed them?
Names of Participants
22. Name of participants
PPS number Type of social welfare payment
participant is currently receiving
23. What are the circumstances of the target group?
24. If the proposed project involves providing a structured training course, please provide the
numbers you expect to participate.
Male:
Female:
Total:
25. If the proposed project involves providing a service (e.g. counselling, guidance, job
search support), please provide the numbers you expect to use the service:
Male:
Female:
Total:
For projects involving training courses
26. Please describe the content and format of proposed course/programme:
27. What are the main learning outcomes you are seeking?
28. List the main modules that will be provided;
29. What is the proposed duration of the course?
30. Is the course part-time or full-time? (e.g. two half-days per week on Mondays & Fridays)
31. How many contact hours of tuition are to be provided to each participant?
32. Who will provide the course?
33. What are the qualifications of the course provider?
34. How will participant progress be assessed?
35. What organisation is the course accredited by?
36. Do you have strategies in place for addressing issues such as abuse (physical and
otherwise) and addictions as they arise during the programme?
37. Do you have strategies in place for appropriate referral, after-care as well as monitoring
and reporting outcomes?
For projects involving services
38. Expected outcomes of proposed project?
39. What are the main benefits that participants will obtain in the short and long term?
40. How will these benefits be assessed?
Timetable for the project
41. Proposed start date:
42. Proposed completion date:
43. Describe the main milestones involved in implementing the project?
Project costs
44. Total cost of project - €
45. Amount of part-funding being sought from the Department of Employment Affairs and
Social Protection?
(If you are applying for funding from the Department which is in excess of €6,350, please attach a
current Tax Clearance Certificate for your group/organisation).
€
46. Please state the amount of funding that your own organisation will provide towards your
project? €
47. Have you sought funding from any other organisations (e.g. ETB) for this project? If so,
what was the outcome?
(If you have not applied for funding to these organisations, please do so before submitting this
proposal to the Department).
48. If matching funding is being provided by another organisation(s), please give details
If another organisation intends to provide funding in excess of €10,000, please attach a letter
from that organisation confirming the amount and purpose of the funding.
For projects costing in excess of €30,000, please provide the names and tax reference
numbers of the service providers.
Name of organisation providing matching funding Amount of funding (€)
49. Please provide an itemised list of projected costs of your programme and the name of
organisation(s) covering the costs where applicable:
Once-off funding
50. The Activation and Family Support Programme fund is administered on a once-off basis.
If you intend to run this programme again in the future, how do you propose to fund it?
Declaration
On behalf of I wish to apply to the
Department of Employment Affairs and Social Protection for funding of €
under its Activation and Family Support Programme as outlined above. I declare that
all of the information contained in this proposal is true and accurate to the best of my
knowledge and belief. I have also read and understood the terms and conditions
pertaining to receipt of funding under this Programme and I confirm that they will be
implemented in full.
Signed:
Date:
Status of signee in group/organisation:
When fully completed, this proposal form should be signed and dated (in ink pen) and
posted, along with any supporting documentation, to Department of
Employment Affairs and Social Protection,
Please note that we can only accept this proposal form in hard copy format.
Checklist:
Please ensure that you send the following documents to the Department:
Check()
1. This Proposal Form (Appendix 1) fully completed and signed/dated.
2. Bank mandate form (Appendix 2) giving details of your organisation’s bank account.
3. Information and conditions for receipt of funding (Appendix 3) under the Activation and Family Support Grant with declaration signed/dated.
4. A current Tax Clearance Certificate (only required if the funding being sought exceeds EUR 6,350).
5. A letter from any other organisation that is part-funding your course/programme by EUR 10,000 or more (if applicable).
Appendix 2
Order for Payment - Activation & Family Support Programme
From: To:
Client /
Project Name:
Date proposal
received:
With reference to the attached invoice/proposal, details of which are set out below, I certify that the
proposal is in order for payment, and the proposal has not been included in any previous payment.
Signed: ________________________ Date: _______________
Case Officer
Approved: _____________________ Date: _______________
Area Manager
AUTHORISED BY: ____________________________ (Budget Holder
GRADE: _________________
DATE: _________________
PAYEE NAME:
ADDRESS:
COST CENTRE: V5465
PAYEE tax reference no:
INVOICE NO.:
AMOUNT: €
PERIOD COVERED:
NATURE OF SERVICE:
NO. OF PEOPLE ASSISTED: TARGET GROUP:
RAPID AREA: CLAR AREA:
Appendix 3 - SUPPLIER SET-UP FORM V05-2017
NOTE: YOU MUST RETURN ORIGINAL OF THIS FORM ONLY Part 1: To be completed by the Company / Individual / Organisation where details have not been previously submitted or have changed. Part 2: ONLY To be completed by authorised Bank Official if changing bank account details currently held by the Department of Employment Affairs and Social Protection.
Part 1 Company / Individual / Organisation Details
Payee Name ______________________________________________________________
Medcert Panel No/DSP Payroll Number (if applicable)__________________________________
Payee Address ____________________________________________________________
Email address _______________________________________________________________ ____
Email address for Purchase Orders (if Applicable)______ _________________________
Tax Registration No/PPS No __________________Telephone No ______________________
If payment/s exceed €10,000 in a twelve month period please supply the following:
Tax Clearance Access No (TCAN): __ __ __ __ __ __ OR attach copy of current Tax Clearance
Cert
Bank Name_______________________________________________________
Address _____________________________________________________________
Account Holder _______________________________________________________
BIC/SWIFT Code
IBAN Number
Payee Signature _________________________ Block Letters ________________________
Date: ______________________________________________
If the payee is not the account holder then the account holder must sign here
Account Holder Signature __________________________ Block Letters
_______________________ Part 2 ONLY To be completed by authorised Bank Official if changing bank
account details currently held by the Department of Employment Affairs and Social Protection.
Bank Official
Signature: _______________________________
Date: _______________________________ OFFICIAL BANK STAMP
DSP use only
Supplier No: Site:
Input by:
Checked by:
Appendix 4
Conditions for Award of Activation & Family Support Programme In the event of acceptance and payment of proposal, the following conditions
apply:-
1. All participants on the programme funded must be in receipt of a qualifying social protection payment or must be the dependents of social welfare recipients and/or their families. Examples of social protection payments include:
o Jobseeker’s Allowance and Jobseekers Transition (incl. Casuals) o Jobseeker’s Benefit (incl. Casuals) o Blind Pension o Deserted Wife's Benefit (DWB) o One-Parent Family Payment (OFP) o Signing on for credits o Carers Allowance
2. Where a proposed programme has participants who are not in receipt of a SW
payment or who are not a dependent of a SW recipient funding will only be provided on a proportionate basis.
3. Details must be provided to the Case Officer of participants including name,
address, PPSN, & the scheme under which they are being paid before funds can be released.
4. The programme provider must have strategies in place for addressing issues
such as abuse (physical or otherwise) and addictions as they arise during the programme. This may involve referral to qualified counsellors or to other appropriate supports.
5. The Case officer must be allowed to visit the training course/project etc from
time to time by prior appointment to see how it is progressing.
6. An evaluation of the programme/project must be submitted to the Department within one month of its completion. A template is available for the evaluation. In the absence of the completed evaluation, the Department will not consider any future applications for the organization for other projects.
NB: If for any reason the programme/course does not go ahead then the Department's Case Officer/Area Manager must be informed immediately or within one week of the proposed start date and arrangements must be made to refund the monies to the Department. 7. Funds provided for the course or project can only be used for the purpose for
which they are provided. Details of expenditure including invoices & receipts must be available for inspection if/when required by the local Case officer.
8. Where the total cost of the project exceeds €30,000 the name(s) and relevant
reference number(s) of the service provider(s) must be stated on the application.
9. Any unspent funding at the end of the programme may not be used for any
other purpose. Such unspent funding must be returned to the Department without delay.
Declaration
Name of group/organisation
__________________________________
I hereby confirm
(1) Receipt of grant of €
(2) The conditions specified above governing the use of funds allocated by
the Department of Employment Affairs and Social Protection is acceptable to
my organisation/company/group and will be implemented.
Signed: _______________ Date___/____/20
Block capitals
Status /Title in organisation
Appendix 5 An Roinn Gnóthai Fostaiochta agus Coimirce Sóisialaí
Department of Employment Affairs and Social Protection
Activation and Family Support Programme
Evaluation Questionnaire
1. Name & address of the organisation which operated the project:
2. Name of project (if applicable):
3. Status and contact details of person
Office phone number
Mobile phone
E-mail address
4. Location(s) where project took place:
5. Was the project in a RAPID or Clár
area? RAPID Clár
6. Were procurement guidelines fully
adhered to by the programme provider?
(please circle as appropriate)
Yes No
7. If no, please elaborate
8. Please state the main groups of
people who benefitted from the project?
Outcomes for project course /programme
9. How many participants started the
course(s) programme provided?
Starters Male Female
Total
10. How many participants completed the
course(s) programme provided?
Completers Male Female
Total
11. How many participants obtained
certification?
Certs Male Female
Total
12. State the certification level (e.g. QQI
level) and the awarding authority.
13. Progression status of participants/
beneficiaries following the
course/programme
Name PPSN
Male Female Total
Employed
Self-employed
Further training
Further
education
On employment
programme
Seeking work
Other
14. What was the main objective of the
project?
15. Details of how course/programme
performed against the original objectives as
outlined in funding proposal
(please circle as appropriate)
Yes
No
If no, please outline the reasons:
16. How were the benefits of the
project/programme for participants or
beneficiaries assessed?
Project Costs
17. What was the total expenditure
associated with implementing this project?
18. What was the total cost incurred by the
Department of Employment Affairs and
Social Protection?
Please list these costs.
19. Was the funding provided by the
Department of Employment Affairs and
Social Protection for this programme fully
used up?
(If not, any unused funding should be
returned to the Department immediately)
20. List the names of other organisations
who co-funded the project and the amounts
involved
Organisation
Amount (€)