section 1 - arts council of northern...

MARCH 2014

ARTS COUNCIL OF NORTHERN IRELAND

NATIONAL LOTTERY PROGRAMME

PUBLIC ART PROGRAMMESupporting the commissioning of new artwork for public places

APPLICATION FORM

Application round opens Deadline for Receipt of Applications

Decision Due

10 March 2014 4pm, Thursday 3 April 2014 July 2014

Please read the guidance notes carefully before you complete this application form.

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INTRODUCTION Notes to help you complete the application form

SECTION ONE Contact details

SECTION TWO Organisation details

SECTION THREE Project Description

SECTION FOUR Finance

SECTION FIVE Equality of Opportunity and Good Relations Commitment, Child Protection Statement, Safe Guarding Checklist and Beneficiaries

SECTION SIX Enclosures

SECTION SEVEN Publicity, Openness and Accountability

SECTION EIGHT Applicant’s Statement

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Applicants are advised to read the full Arts Council 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.

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.

You can apply on-line via the Arts Council’s website – www.artscouncil-ni.org

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.

The information you provide may be used by 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

Please complete and return the application form and enclosures. The form must have an original signature.

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.

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

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

MARCH 2014

INTRODUCTIONNOTES TO HELP YOU COMPLETE THE APPLCIATION 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 with you have provided 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.

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

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

Section 2 – Organisation Details

A. If you have received a grant since 1st April 2004 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 organsiations 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 who have been in permanent employment since April 2009 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 2009.

9. You must complete this section, stating either your Access NI registration details, the name of your umbrella body or why your organization does not have to be registered.

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

Section 3 – Project Description

1. Give a description of the activity you are asking us to support. We will use this to decide who should assess your application and also to present a short outline of your project to our Council, to the public and in any reports or publications linked with this programme.

You are also required to supply a full description of your project (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. Please give the total number of artists who may be shortlisted and commissioned.

Section 4 – Finance – Category 1

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.

Remember that the Arts Council will not pay for your entire project. The most the Arts Council will pay is 90% of the total costs. If you are a statutory body the Arts Council will only pay up to 50% of the costs.

2. You should list ALL the other funders of your project. If you are seeking funding for THIS project, or if you have already received funding for THIS project from an NI Lottery Distributor, you should give details here. The other NI Lottery Distributors are: Sports NI; Heritage Lottery Fund; Big Lottery Fund.

Section 4 – Finance – Category 2

3. 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.

Remember that the Arts Council will not pay for your entire project. The most the Arts Council will pay is 90% of the total costs. If you are a statutory body the Arts Council will only pay up to 50% of the costs.

4. You should list ALL the other funders of your project. If you are seeking funding for THIS project, or if you have already received funding for THIS project from an NI Lottery Distributor, you should give details here. The other NI Lottery Distributors are: Sports NI; Heritage Lottery Fund; Big Lottery Fund.

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Section 5 – Equality of Opportunity, Good Relations Commitment, Child Protection, Safe Guarding Checklist and Beneficiaries

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.

Applicants should note that, in carrying out its functions, the Arts Council may check the content of newspapers, websites and other documents to establish that the organisation is acting within the ethos of good relations. Where evidence is found that an applicant is not acting in the interests of good relations, applications will be considered ineligible or, if evidence is found after an award is made, funding will be withdrawn. The Arts Council will not distinguish between an organisation’s official website and social networking sites created by, or containing entries from organisation members.

It may be in the interests of the organisation to establish a policy among its members regarding websites and the posting of material relating to the organisation’s activities.

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, 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. 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 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.

In addition to signing the Child Protection Policy statement and completing the Safeguarding Checklist, you are also required to submit a copy of your Child Protection/Safeguarding Policy and Procedures (see Enclosures section) Please note Policy and Procedures which are older than 3 years will not be accepted. If your Policy and Procedures are older than 3 years please review and update to ensure your policy and procedures are in line with best practice and legislation relating to protection issues.

Beneficiaries: 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.

Section 6 – Enclosures

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

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1) Constitution and/or Memorandum and Articles of Association2) Organisation’s Equal Opportunities Policy3) Organisation’s Child Protection Policy (if applicable)

All other organisations must submit the required documents.

Enclosure documents:

1) 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) Equal Opportunities Policy: This document must be signed and dated as adopted. This policy must be a separate document. It is not the clause in your constitution and it is not the one page equality statement within this application form.

3) Child Protection Policy: You only have to submit this document if your organisation works with children. This policy must be signed and dated as adopted. This policy must be a separate document. It is not the clause in your constitution and it is not the one page Child Protection Policy statement within this application form.

4) Safeguarding Checklist: You only have to submit this document if your organization works with children, young people or vulnerable adults

5) Your project description should be no more than 2,500 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; Location of the project and any other events associated with it; 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 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;

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

The Council recognises that names of artists, locations of events, for example, may not be known at this stage.

6) You MUST attach a detailed description of how your project meets each of the following criteria as listed in the Guidance Notes. Identify and address each sub-criterion separately in no fewer than 200 and no more than 300 words.

Criterion 1: Public benefit i) The project contributes to Arts Council strategy/public art policy.

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ii) The project contributes to the growth of arts in the community or to new/existing audiences, and reflects the diversity of NI society.

iii) The project has an effective documentation and marketing strategy associated with the commission.

Criterion 2: Artistic Quality i) The project offers creative vision and an imaginative brief/plansii) The proposal outlines the production/presentation/facilitation

process.iii) The project has the ability to support artists/performers/facilitators.iv) The proposal details the artists/facilitators who will be involved.

Criterion 3: Organisational and Project Viability i) The project is well planned.ii) The organisation demonstrates good practice in terms of governance.iii) The organization demonstrates good practice in terms of financial

management.

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

7) You should provide a detailed income and expenditure budget for ALL years of the project. You should include a breakdown of any budget line over £1,000. You should also include details of how you have calculated any fees you are paying, eg 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

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

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

You cannot include the costs of employing committee/board members or directors of the organisation to work on the project as research shows that the public regard this as inappropriate use of 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.

8) We require a projected income and expenditure budget for your organisation for the year/s 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 is most cases this will be a much larger budget detailing all of the organisation’s activity.

9) We require a copy of the most recent audited/certified accounts of the organisation. These must be signed and dated as adopted by the organisation. 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. 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.

10) 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 what you want these funds for. There may be additional costs such as translations, sign language interpretation, braille paperwork, transport costs, provision of creche 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.

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

12) Whether you are applying for a Category One – Commissioning, or Category Two – Production award you must include the artist’s brief for the project. The brief should include: the vision; details of team members; selection process; working context; budget; timescale, requirements as to durability, maintenance, health and safety; themes (if there are any); technical information; site.

12) If you have chosen the artist you must include the artist’s CV along with details of how s/he has been selected.

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SECTION ONE - CONTACT DETAILS

1. Name of Organisation:

________________________________________________________________________

2. Address of Organisation:

________________________________________________________________________

Town ___________________________________ Postcode ______________________

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

Web site: ________________________________

Local Authority Area _______________________

3. Name of contact person within organisation who will deal with all correspondence:

____________________________________________________

4. Position of contact person within organisation:

____________________________________________________

5. Details of contact person (if different from 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 since 1st April 2006:- 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 ______________________________

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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? _______________________

9. 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.

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10. If you are successful in obtaining an award all payments will be made directly into a bank account. Please supply full details below:

Name of Bank/Building Society _____________________________________

Address ________________________________________________________

Town__________________________ Postcode ________________________

Account Name ___________________________________________________

Account Number _____________________

Sort Code - -

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SECTION THREE – PROJECT DESCRIPTION

1. Please describe the project for which you are seeking funding in no more than 200 words. This description will be presented to Council as part of its decision making process.

A more detailed prroject description must also be enclosed as well as a detailed description of how your project meets the stated priorities and criteria. You should identify and address each criterion separately in no fewer than 200 and no more than 500 words (see introduction section for further details). This is for use by Arts Council officers in assessing your application

2. How many artists do you estimate will be employed in your project? _____________

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SECTION FOUR – FINANCIAL DETAILS – CATEGORY ONE

Note: If you are VAT registered please quote all figures net of VAT. If you are not VAT registered please quote gross costs.

1. Summary Income and Expenditure Budget for THIS PROJECT. A more detailed budget must also be enclosed for use by Arts Council officers in assessing your application. See FAQs section

EXPENDITURECost

£Category 1: CommissioningArtists’ feesResearch costsAdvertisingAdministrationPremium CostsTOTAL COSTS

INCOME (Criterion 4)Source Income

£Arts CouncilBox office*Grants (non Arts Council)FeesProgramme salesOther (Please specify)

TOTAL INCOME

2. *Please list below the individual funders included in the *Grants (non Arts Council) above (You should enter a figure (£) in one column only)

Funder

Applied for£

Provisionally offered

£

Guaranteed

£

Please indicate whethercash or

“in-kind”

TOTAL

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SECTION FOUR– FINANCIAL DETAILS – CATEGORY TWO

Note: If you are VAT registered please quote all figures net of VAT. If you are not VAT registered please quote gross costs.

3. Summary Income and Expenditure Budget for THIS PROJECT. A more detailed budget must also be enclosed for use by Arts Council officers in assessing your application. See FAQs section

EXPENDITURECost

£Category 2: ProductionProduction/Presentation costsRecording costsPublicity/Distribution costsPremium Payment costsTOTAL COSTS

INCOME (Criterion 4)Source Income

£Arts CouncilBox office*Grants (non Arts Council)FeesProgramme salesOther (Please specify)

TOTAL INCOME

4. *Please list below the individual funders included in the *Grants (non Arts Council) above (You should enter a figure (£) in one column only)

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, SAFEGUARDING CHECKLIST AND BENEFICIARIES

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

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.

Applicants should note that, in carrying out its functions, the Arts Council may check the content of newspapers, websites and other documents to establish that the organisation is acting within the ethos of good relations. Where evidence is found that an applicant is not acting in the interests of good relations, applications will be considered ineligible or, if evidence is found after an award is made, funding will be withdrawn. The Arts Council will not distinguish between an organisation’s official website and social networking sites created by, or containing entries from organisation members.

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

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. 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 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.

In addition to signing this statement, you are also required to submit a copy of your Child Protection/Safeguarding Policy and Procedures (see Enclosures section) Please note Policy and Procedures which are older than 3 years will not be accepted. If your Policy and Procedures are older than 3 years please review and update to ensure your policy and procedures are in line with best practice and legislation relating to protection issues.

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 Checklist

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 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

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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

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BENEFICIARIES - Telling Us About The People Who Will Benefit from this project

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

1. Persons with a Disability

The main group to benefit:(by main group we mean more than 60%)

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:(by main group we mean more than 60%)


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

3. Persons with Dependants



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

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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.

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.

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4. Religious Belief

The main group to benefit, will be: (by main group we mean more than 60%)


ProtestantCatholicBoth 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



Nationalist generallyUnionist generallyOtherWe are unable to specify which group will mainly benefit

6. Racial Group



Black 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



MarriedUnmarriedDivorcedSeparatedWidowedWe are unable to specify which group will mainly benefit

8. Sexual Orientation



Gay peopleLesbian peopleHeterosexual peopleBisexual peopleWe are unable to specify which group will mainly benefit

9. Age



Under 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%

1. 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%)

2. Men and Women



Women (including girls)Men (including boys)Transgendered peopleBoth women and men(where neither community is over 60%)

3. 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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4. Religious Belief



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

5. Political Opinion



Nationalist generallyUnionist generallyOtherWe are unable to specify

6. Racial Group



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

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7. Marital Status



MarriedUnmarriedDivorcedSeparatedWidowedWe are unable to specify

8. Sexual Orientation



Gay peopleLesbian peopleHeterosexual peopleBisexual peopleWe are unable to specify

9. Age



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

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SECTION SIX – ENCLOSURESApplicants in receipt of awards under the Arts Council’s Annual Funding Programme 2014/15, 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 Child Protection Policy (if applicable)3) Organisation’s Equal Opportunities Policy

All other organisations must submit the required 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.

tick if enclosed

Document

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

Copy of your Equal Opportunities Policy/Statement (signed and dated as adopted). This policy must be a separate document. It is not the clause in your constitution and it is not the one page equality statement within the application form.

Copy of Child Protection Policy (if applicable, signed and dated as adopted). This policy must be a separate document. It is not a clause in your constitution and it is not the one page Child Protection Policy statement within the application form.Completed Safeguarding Checklist (if applicable). This document is additional to your organisation’s child protection policy.Detailed description of THIS project (See Introduction Notes)

Details of how your project meets the Public Art Programme criteria (See Introduction Notes)

Detailed income and expenditure budget for THIS project

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

Copy of most recent certified or audited accounts (signed and dated as adopted). 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 the most recent set of management accounts (signed and dated as adopted), which should be within the specified period.

Details of premium payment costs, if applicable

Copies of any available letters of offer from partnership funders or sponsors

Artist’s brief for this project (see p.9 of the introduction).

Chosen artist’s/s’ cv and details of selection process (if artist has already been selected).

Please ensure you enclose the original application form and enclosures.

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MARCH 2014

SECTION SEVEN - 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.

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.

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, 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 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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MARCH 2014

SECTION EIGHT - APPLICANT’S STATEMENT

Please complete the section below to authorise your application. The Chair of the organisation or a committee member should sign this declaration and the most senior employee or one other committee member must witness it.

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

Copy of your organisation’s Child Protection Policy (if applicable) 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 or committee member): __________________________________

Designation: ____________________________________

Signature: ______________________________________

Date: __________________________________________

Name (Senior employee or second 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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