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OCTOBER 2014

DERRY CITY COUNCIL &

ARTS COUNCIL OF NORTHERN IRELAND

LEGACY FUND

APPLICATION FORM

Application round opens

Deadline for Receipt of applications Decisions by

31 October 2014 4.00 pm, Thursday, 15 January 2015 Mid April 2015

LATE APPLICATIONS WILL NOT BE ACCEPTED

This application round is for projects taking place between May 2015 – March 2017

Please read the Guidance Notes and Introduction carefully before you complete the application form.

If you need assistance to complete this application form please contact the Arts Council’s Arts Development Department on 028 9038 5200

Applicants are advised to read the full programme 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.

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On line application You can complete the form and attach all required documents on-line. If you choose to submit on-line, you must submit ALL documents and the application form at the same time, there will be no opportunity to submit documents after the deadline.

Hard Copy applicationThe application form may be typewritten or handwritten. If handwritten, it should be completed in block capitals and black ink. The Arts Council reserves the right to reject applications which it cannot read.

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

If you choose to submit in hard copy, ALL documentation must be supplied in hard copy.

Note: The Council will not accept applications partly on-line and partly in hard copy.

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, for producing statistics and publicity information on successful grants. 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. The information may also be made available to other departments/agencies for the purposes of preventing or detecting fraud.

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

NOTE: it is your responsibility to ensure that the Arts Council receives the application form and documents by the closing date within the required timescale. You should also note that proof of postage is not proof of delivery. The Arts Council accepts no responsibility for applications/documents which are delivered late by the Post Office or other carriers.

REMEMBER TO KEEP A COPY OF THE APPLICATION FORM AND ENCLOSURES FOR REFERENCE.

Completed application forms should be returned to:Arts Council of Northern Ireland 77 Malone RoadBELFASTBT9 6AQ

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INTRODUCTION

NOTES TO HELP YOU COMPLETE THE APPLICATION FORM

This section is designed to help you fill in each of the questions on the form. Please refer to them as you complete each question, as the detail we require may be different from that which you have provided us with on any previous application.

Section 1 – Contact details

1. This must be the same name as that on your Constitution, and on your Bank Account2. This is the address and details of the organisation’s headquarters or the place where your

organisation meets3. The name of the person who can be contacted during working hours and who is authorised to

answer all questions relating to this application on behalf of the organisation. Please ensure that this person is going to be available and is not away on business/ holiday during the period that the application is being assessed. The Arts Council will not accept responsibility for missing information or misinterpretation of the form where the contact person has not been available at any of the contact details given.

4. Is this person the chairman, treasurer, secretary or do they hold another position within the organisation

5. If the contact person does not work at the address given at (2) above, then please give other contact details.

Section 2 – Organisation Details

A. If you have received an award from the Arts Council since 1st April 2009 we already hold some of your organisation’s details on computer and you do NOT have to fill in questions 1 and 2. You should only complete questions 3 and 4 if details have changed since your last application. You MUST complete questions 5, 6, 7, 8, 9 and 10.

B. All NEW applicants must complete all questions.

1. What is the mission statement of your organisation and/or what are its main objectives, as laid out in your Constitution. This should NOT be a list of projects that you have carried out.

2. This should be the date on your organisation’s constitution or certificate of incorporation3. Most clubs and societies are unincorporated.4. Unless you are an organisation with a base in Great Britain where charities are registered, the

Inland Revenue in Northern Ireland recognises organisations as having a charitable purpose. You should quote here your Inland Revenue reference number, if you have one.

5. If you are VAT registered you should quote your reference number here. The Arts Council will not pay VAT incurred by VAT registered organisations.

6. You should complete this section with the names of the Chairman, Secretary and Treasurer or the equivalent committee positions in your organisation

7. You should give the total number of staff of who have been in permanent employment since April 2013 whether they are full- time or part-time. Do not include freelance consultants or short term contract staff

8. Include your full committee and board members and any other members of the public who have volunteered to provide services to you since April 2013

9. If you are successful in obtaining a grant, payments will be made directly into your bank/building society account. Please ensure these details are correct.

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10. All organisations working with children/young people/vulnerable adults are subject to Safeguarding legislation. You should complete the relevant section (a) or (b). If neither of these is relevant you should complete (c) given clear reasons why your activities are not subject to this legislation.

Section 3 – Project Description

1. Give a description of the activity you are asking us to support in no more than 100 words. We will use this to decide who should assess your application and also to present a short outline of your project to both Councils, to the public and in any reports or publications linked with this programme.

You are also required to supply an additional full description of your project, as well as a detailed description of how your overall programme meets each of the programme criteria (see Section 6 – Enclosures). The amount of information you need to provide will depend on how long or complicated your project is. This is a VERY IMPORTANT part of the application process.

2. Indicate what you think the main artform of your activity is.

3. Indicate if your project meets any of the programme aims. Projects which don’t meet either aim are unlikely to be supported.

Section 4 – FinanceNote: the maximum grant available under this programme is £75,000.

1. Give the total gross costs of your project over the life of the project. If you are VAT registered you should quote net figures. If you are NOT VAT registered you should quote gross costs.

2. Remember that the Legacy Fund will not pay for your entire project. The most the Legacy Fund will pay is 90% of the total costs. Of the 10% you are required to find, half of this must be in cash (ie 5% of the total project cost must be cash). The balance can be made up from in-kind funding.

3. You should give the anticipated expenditure for the whole project.

4. You should give the anticipated income for the whole project. The total sum given here, plus the amount you are seeking from the Arts Council should add up to the total cost of your project.

5. You should list ALL the other funders of your project.

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Section 5 – Equality of Opportunity, Good Relations Commitment, Child Protection and Safeguarding Checklist

It is a requirement of the funding conditions of all Arts Council of Northern Ireland programmes that your organisation commits to equality of opportunity and good relations duty. Therefore, this Statement MUST be adopted by your organisation.

It is also a requirement of the funding conditions under all Arts Council of Northern Ireland programmes that an organisation intending to work with children and young people commits to a Child Protection Policy. Therefore, this Statement MUST be adopted by your organisation if any aspect of your work is aimed at children and young people.

Due to changes in Government legislation, all organisations dealing directly with children, young people and vulnerable adults MUST complete and return the Safeguarding Checklist. This document is additional to the organisation’s child protection policy. The document must have been agreed by your organisation and should be signed and dated. If you are unable to tick all boxes as “yes” at the time of submitting the application, you must take steps to address all the issues prior to drawdown of any awarded funds. Government has issued guidance that no funds should be paid across to organisations until they are able to sign up completely to the checklist.

Section 6 – Enclosures

Applicants in receipt of an award from the Arts Council’s, Annual Funding Programme in 2013/14, who submitted the documents listed below for the Arts Council Masterfile and have not amended the documents since they were submitted, do not have to provide the following documents:

1) Constitution and/or Memorandum and Articles of Association2) Organisation’s Equal Opportunities Policy

All other organisations must submit the required documents.

Enclosure documents:

1) Copy of your Constitution and/or Memorandum and Articles of Association: This document must be in the same name as your bank account and the same name as that given in Section 1 of the application form. It must be signed and dated as adopted.

2) Copy of your Equal Opportunities Policy: This policy document must be signed and dated as adopted

3) Detailed Project Description: Your project description should be between 2,500 and 5,000 words.

You should describe in detail the project you wish to deliver, describing the overall aims and objectives of the project and all the activities within the project. You should also include:

Start and finish dates of the project; Locations of all events within the project; Names of artists, tutors, facilitators (if known) for each event or project; OR details

of the process you intend to use to select the artists

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Projected participation in each event or project – numbers and age ranges – whether they will actively participate or will be an audience for a final presentation;

For organisations whose programme includes the production of artistic material (journals, magazines, or books, film, CD, or other media) a list of titles with print run and projected sales. Such organisations should also document promotional events associated with these materials (launches, readings, viewings, etc.);

Name of Project Manager for each major element, along with experience statement.

For some activities we need additional information. If you are applying for audience development activity we need to see evidence that you have consulted with Audiences NI and that you have developed a coherent planIf you are applying to bring international work to NI you should complete the venue schedule.If you are applying to tour a production we need to see a proposed tour itinerary and letters from the proposed venues indicating that they would be interested in the production.

4) Detailed description of how your overall programme meets each of the Programme criteria as listed in the Guidance Notes and as detailed below: Identify and address each criterion (including all sections) in no fewer than 200 and no more than 500 words. You must address and number the sections within each criterion separately as below so that the assessing officer can clearly see which criterion section you are addressing.

Artistic ProgrammeThe application must demonstrate:

a strong artistic vision that is well communicated that the artistic vision is delivered through the agreed aims/objectives and principles

of the Legacy Fund programme

Public BenefitThe application must demonstrate:

there will be a positive and sustainable legacy from the project there will be proactive targeting of underrepresented groups and communities not

currently participating in cultural activity with the continuation and development of the ‘Edge to Centre approach, bringing those on the edge of the City's cultural life to the heart;

the project will add value by making a contribution to social and economic regeneration with targeting of programmes at areas in greatest need;

the project will develop local talent and transform citizens from passive consumers to active creators.

Management. Governance and FinanceThe application must demonstrate:

good practice in terms of governance good practice in terms of financial management that the organisation has the capacity to deliver the proposed programme

Note: there is no need to address Criterion 4 as this is assessed against the information given in the Finance section.

5) You should provide a detailed income and expenditure budget for the project. You must include a breakdown of any budget line over £1,000 and itemise expenditure wherever

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possible. You should also include details of how you have calculated any fees you are paying, e.g. hourly/daily/weekly rates. Where box office or programme/book sales are shown you should include details of pricing and numbers of tickets/publications to be sold.

The Arts Council recognises non-monetary forms of assistance to a project, such as members of the public wishing to contribute time, experience and expertise to arts

groups or organisations; young people wishing to contribute time but who also wish to gain work experience

and or accreditation and training; professionals and or consultants wishing to donate their time, professional

experience and expertise to organisations who would benefit from this resource; employers who encourage and support employees in volunteering to bring their time,

knowledge and expertise to groups and organisations requiring assistance; free use of premises and/or equipment free access to other services

“In-kind” funding does not include the time given by your committee or board members to carry out their regular duties

If you are including “in-kind” support to your project you MUST demonstrate how you have calculated this. The Arts Council accepts:

the equivalent of the hourly minimum wage for members of the public and young people contributing time as described above;

a limit of £120 a day for professionals and/or consultants and employees volunteering their time;

the costing by the supplier for the use of premises, equipment and other services

You cannot include the costs of employing committee/board members of directors of the organisation to work on the project as research shows that the public regard this as inappropriate use of Lottery funds which are to be used for wider public benefit rather than private gain.

You cannot include the costs of gratuitous hospitality or alcoholic beverages. The only hospitality costs we will pay for are where they are integral to the project, for example, an arts conference where lunch is provided to delegates.

6) We require a projected income and expenditure budget for your Organisation for the year in which the project will take place. In some cases this may be the same as the income and expenditure budget for the project where this is the only activity of the organisation, but in most cases this will be a much larger budget detailing all of the organisation’s activity.

7) We require a copy of the organisation's certified or audited accounts. These must be signed and dated as adopted by the organisation. The accounts should be to a date at most 9 months prior to the date of your application. If this is not available please provide the most recent certified or audited accounts (signed and dated as adopted) and in addition the most recent set of management accounts (signed and dated as adopted), which should be within the specified period. We require these accounts to assess the overall financial wellbeing of the organisation and to judge whether there is a need for Arts Council funding.

8) If your project is being delivered to a Section 75 group as detailed in The Northern Ireland Act 1998, and you are seeking additional funds for this purpose, you must detail exactly

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what you want these funds for. There may be additional costs such as translations, sign language interpretation, Braille paperwork, transport costs, provision of crèche facilities. You will not receive these funds in advance and, in order to claim the funds, you will have to demonstrate numbers of people involved in receiving these services.

9) If you have any letters from sponsors or other funders you should include them with your application as demonstration of support.

10) You must provide a list of your organisation’s current board members, which details any relevant specialism each brings to the role.

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SECTION ONE – ORGANISATION CONTACT DETAILS

1.1 Name of Organisation:

This should be the full registered name of the organisation and should match the name on the constitution and/or company registration.

1.2 Address of Organisation:

_____________________________________________________________________

Town ___________________________________ Postcode___________________

Phone number: ______________________ Fax Number:___________________ E-mail address: ________________________________

Web site: ________________________________

Local Authority Area: _______________________

This should be the organisation’s address (its headquarters, rehearsal/performance venue, or regular meeting place). It should only be a home address of the Secretary or other committee member if the organisation does not have its own regular meeting place.

1.3 Name of contact person within the organisation who will deal with all correspondence:

____________________________________________________

The person named here must be authorised to answer all queries and to sign all paperwork relating to this application. Please ensure that the person will not be out of the country/ unavailable during the period Feb/Mar/April as we may require answers to queries in order to assess the application. The Arts Council will not be responsible for communications which remain unanswered due to unavailability of the person named as the contact.

1.4 Position of contact person within the organisation: ______________________________

1.5 Details of contact person (if different from1.2 above):

Address: ________________________________________________________________

Town: _________________________ Postcode: __________________________

Phone number: ______________________ Fax Number: _____________________

E-mail address: ________________________________

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SECTION TWO - ORGANISATION DETAILS

(Please note: If you have received a grant from the Arts Council since 1st April 2009: DO NOT complete questions 1 and 2 Only complete items 3 and 4 if circumstances have changed since your last application. Complete all other questions .

1. What does your organisation do (no more than 100 words)?

2. In what year was your organisation started?

3. What type of organisation are you? ()

Unincorporated club or associationCompany limited by guaranteeCompany limited by sharesRecognised charityTrustLocal AuthorityOther: Please specify______________________

4. Recognised Charity Number (if applicable) ________________________

5. VAT Registration Number (if applicable) _______________________

6. Please list the names and positions of the 3 main office-holders in your organisation:

Name _________________________ Position ______________________________

Name _________________________ Position ______________________________

Name _________________________ Position ______________________________

7. How many permanent paid staff (if any) work for your organisation? __________

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

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10. Name of Bank/Building Society _____________________________________

Address ________________________________________________________

Town__________________________ Postcode ________________________

Account Name ___________________________________________________

Account Number _____________________

Sort Code - -

11. 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.

OR

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

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SECTION THREE – PROJECT DESCRIPTION

1. Please describe the project for which you are seeking funding in no more than 100 words. This description will be presented to Council as part of its decision making process. A more detailed project description must also be enclosed (see Section 6 – Enclosures).

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2. What is the main artform in your project?

Music DanceDrama LiteratureTraditional Arts OperaVisual Arts Other: Please specifyArchitecture _______________________FilmCraft No single artform

3. Does your project meet any of the programmes aims? (tick )

(a) To build a sustainable cultural environment which will nourish and enhance a unique world class experience

(b) To unleash talent to build a proud, ambitious, creative connected community

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SECTION 4 – FINANCEPlease note you are required to submit a detailed project budget itemising all items over £1000 as an enclosure to the application form.

1. What is the total cost of your project? ______________________

2. How much are you asking the Arts Council for? _______________

3. What is the project expenditure?

Expenditure £Artists’ costsEquipment/materialsPublicity/marketingTravel/accommodationVolunteer expensesTransportationPremium costs (costs of delivery to Section 75 groups, eg sign language interpretation)Administrative costs attributable to this projectOther: (please specify)

TOTAL

4. Where is the partnership funding coming from?

Source Income £Box office* Grants (non Arts Council/Derry City Council)* SponsorshipFeesProgramme salesOther (Please specify)

TOTAL INCOME

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5. Please list below the individual funders included in the *Grants(non Arts Council/Derry City Council) and *Sponsorship lines above for the project (You should enter a figure (£) in one column only)

*Individual Funder

Applied for£

Provisionally offered

£

Guaranteed

£

Please indicate whethercash or

“in-kind”

TOTAL

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SECTION FIVE – EQUALITY OF OPPORTUNITY, GOOD RELATIONS COMMITMENT , CHILD PROTECTION STATEMENT AND SAFEGUARDING CHECKLIST

With the exception of the Safeguarding Checklist, if you have previously submitted these documents to the Council, you do not have to complete this section but you must re-affirm your commitment to the principles (see Section 8). You must complete and submit the Safeguarding Checklist as part of this application.

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 ……………………………………………………………………

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CHILD PROTECTION POLICY STATEMENT

If you have previously submitted these documents to the Council, you do not have to complete this section but you must re-affirm your commitment to the principles (see Section 8).

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 ……………………………………………………………………

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SAFEGUARDING CHECKLISTDue to changes in Government legislation, all organisations dealing directly with children, young people and vulnerable adults MUST complete and return the Safeguarding Checklist. This document is additional to the organisation’s child protection policy. The document must have been agreed by your organisation and should be signed and dated. If you are unable to tick all 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 awarded funds. Government has issued guidance that no funds should be paid across to organisations until they are able to sign up completely to the checklist.

Government has also issued best practice guidance which states that all child protection policies should be updated every 3 years. If your organisation’s policy is more than 3 years old you are asked to revisit it in the light of current legislation.

Organisation 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 website

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 declarationRecord of interviewFollow-up on written references

Are all staff and volunteer appointments subject to 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.

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

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SAFEGUARDING CHECKLIST

Question Types of evidence Yes No CommentsAre 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 stakeholdersWhistle blowing policy

Does your organisation have written procedures for Designated Officers?

Written documents stating the name and up to date contact details of Designated Officers.

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, endorsed and approved by your Management Board?

Written Policy StatementPlease 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

This Safeguarding Checklist was completed by us on

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

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.Please see the Arts Councils website, from the Home page click on ‘About the Arts’ then click on Youth Arts. See Publications and Information for a link to the Child Protection Best Practice Guidelines.www.artscouncil-ni.org/news/2008/files/Child Protection.pdf

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http://www.artscouncil-ni.org/news/2008/files/Child%20Protection.pdf

OCTOBER 2014

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.)

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 onlyPeople 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 onlyWomen (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

3. 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 onlyPeople 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

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4. 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

5. Political Opinion

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

benefit

6. 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

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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

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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 only

People with a DisabilityPeople without a DisabilityPeople with a Disability and People without a

Disability(where neither community is over 60%)

11. Men and Women



Women (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.



People with dependantsPeople without dependantsPeople with dependants and people without

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

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13. Religious Belief



ProtestantCatholicBoth Protestant and Catholic communities(where neither community is over 60%)BuddhistHinduIslam / MuslimJewishSikhOther Religious BeliefWe are unable to specify

14. Political Opinion



Nationalist generallyUnionist generallyOtherWe are unable to specify

15. Racial Group


Please ()one box only

Black AfricanBlack CaribbeanOther Black BackgroundIndianPakistaniBangladeshiOther Asian BackgroundChineseMixed ethnic groupIrish TravellerWhiteOther (Please specify)We are unable to specify

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16. Marital Status



MarriedUnmarriedDivorcedSeparatedWidowedWe are unable to specify

17. Sexual Orientation



Gay peopleLesbian peopleHeterosexual peopleBisexual peopleWe are unable to specify

18. Age



Under 16Aged 16 – 25Aged 26 – 50Aged 50 – 65Over 65We are unable to specify

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SECTION 6 - ENCLOSURES

Applicants in receipt of AFP funding in 2014/15, who submitted/ confirmed the documents listed below for the Arts Council Masterfile and have not amended the documents since they were submitted, do not have to provide the following documents:

1) Constitution and/or Memorandum and Articles of Association2) Organisation’s Equal Opportunities Policy

Please check that you have enclosed the following documents. If you fail to submit the necessary documentation or fail to provide a statement indicating why it is not applicable, you will be contacted and asked to respond within five working days. Failure to respond within the deadline will render your application ineligible.

Please tick if enclosed

Document

1. Copy of Constitution and/or Memorandum and Articles of Association (signed and dated as adopted)

2. Copy of your Equal Opportunities Policy/Statement (signed and dated as adopted)

3. Detailed description of THIS project (see Guidance Notes and pages 6 and 7 of this application form)

4. Description of how your project meets the programme criteria (See Guidance Notes)

5. Detailed income and expenditure budget for THIS project. You MUST attach a detailed breakdown of the expenditure you expect to incur. Provide as detailed a budget as possible, including a breakdown of any budget line over £1,000. Itemize all expenditure where possible. If you are including ongoing overhead/administrative costs you must indicate how you have calculated the total amount e.g. total annual rent & rates (£X) – amount attributed to this project (£Y).

6. Copy of the organisation’s income and expenditure budget for the year in which the project will happen.

7. Copy of the organisation’s most recent annual accounts dated and signed as approved by a senior member of the management committee/relevant officer of the statutory body. These should be to a date at most 9 months prior to the date of your application. If this is not available please provide the most recent certified or audited accounts (signed and dated as adopted) and in addition the most recent set of management accounts (signed and dated as adopted), which should be within the specified period

OR (for newly established groups only)

8. an estimate of the organisation’s income and expenditure for the first year, dated and signed as approved

AND three months’ worth of original, consecutive bank statements, the most

recent of which is not more than 3 months old OR

photocopies of the pages of the organisation’s 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’

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OR the last three months’ transactions of the organisation’s Internet Account

signed and dated by the Treasurer, OR

(for new groups which do not have three months’ worth of bank statements), all the statements the organization has

9. Copies of any available letters of offer from partnership funders or sponsors (if available)

10. List of your organization’s current board members, detailing what specialism they bring to their role.

If applicable you should also enclose the following documents.Script/score/design details or equivalent if applying for the production of a new workCVs of proposed artists (if known)

Please ensure you enclose the original application form and enclosures.

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SECTION 7 - PUBLICITY, OPENNESS AND ACCOUNTABILITY

PublicityFull listings of all the grants we award are published in our Annual Report and on our website. You will be required to acknowledge Arts Council of Northern Ireland funding in all your publicity. Failure to credit the Arts Council of Northern Ireland will affect payment of your grant.

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.

Data protectionData 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, any 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 that 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 Arts Council of Northern Ireland.

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.

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SECTION 8 - APPLICANT’S STATEMENT

Please complete the section below to authorise your application. The Chair of your organisation must sign this declaration and the most senior employee or one other committee member must witness it. Please note that electronically scanned signatures are not acceptable.

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 immediately and fully to inform the Arts Council of Northern Ireland if any changes in circumstances require the application to be amended.

I confirm that the following documents, submitted/ confirmed for the Arts Council Masterfile, have not been altered since they were originally submitted:

Copy of Constitution and/or Memorandum and Articles of Association Copy of your organisation’s Equal Opportunities Policy

I confirm that we remain committed to the principals outlined in Section 5;

Equality of Opportunity and Good Relations CommitmentChild Protection Policy Statement

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): __________________________________

Designation: ____________________________________

Signature: ______________________________________

Date: __________________________________________

Name (Senior employee or committee member) __________________________

Designation: _____________________________________

Signature: _______________________________________

Date: ________________________________

The information provided on this form may be available to other departments/ agencies for the purposes of preventing or detecting fraud. If you knowingly falsify information on the application form, payments will be stopped and you will have to repay grants already received.

REMEMBER TO KEEP A COPY OF THE APPLICATION FORM AND ENCLOSURES FOR REFERENCE.

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