APRIL 2017

ARTS COUNCIL OF NORTHERN IRELAND

NATIONAL LOTTERY PROGRAMME

PROJECT FUNDINGFor projects which will be completed by

30 June 2018.

THIS IS A SAMPLE APPLICATION FORM ONLY. YOU MUST SUBMIT APPLICATIONS ON LINE. THE ARTS COUNCIL WILL

NOT ACCEPT HARD COPY APPLICATIONS.

Application round opens Deadline for Receipt of applications Decision Due6 April 2017 4pm, Thursday 27 April 2017 30 June 2017

Please read the Guidance Notes and Introduction carefully before completing the online application.

If you need assistance to complete this application form please contact the Arts Council’s Arts Development Department on 028 92 623555

1

APRIL 2017

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

SECTION SIX Equality Monitoring

SECTION SEVEN Child/Young People/Adults at Risk Protection Policy Statement

SECTION EIGHT Enclosures

SECTION NINE Publicity, Openness and Accountability

SECTION TEN Applicant’s Statement

Applicants are advised to read the full guidelines before completing any section of the online 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.

YOU MUST APPLY ONLINE. THE ARTS COUNCIL WILL NOT ACCEPT APPLICATIONS IN ANY OTHER FORMAT.

All applications must be made via our online system and must be submitted by 4.00 pm on the closing date. The Arts Council will not accept any application which is received after the closing time/date. Please note that the online system can slow down considerably in the last few hours prior to the closing deadline due to the number of applicants using the system. It is your responsibility to ensure that your application is submitted in time.

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

2

APRIL 2017

INTRODUCTION

How to applyYou must apply online. We will not accept applications in hard copy or by email or by fax.

Online applications may be edited, saved and returned up to the closing date. You MUST submit ALL mandatory enclosures associated with the application at the same time, ie. at the point at which you submit your online application. These enclosures are listed within the online application and also on page 29 of this sample application document (available for download on our website).

The online application allows you to upload and attach the necessary enclosures to your application. All such documents must be in Word, Excel or pdf format. We cannot accept documents in other formats. Total size of documents should not exceed 25 Mb.

Please ensure that you leave sufficient time to upload all documents to the system as there can be long delays as the closing deadline approaches and the system will shut down at 4.00 pm on the closing date. If your complete application is not uploaded when the system closes, your application will not be accepted.

It is your responsibility to ensure that we receive the application form and documents by the closing time and date.

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 information on successful applicants. Remember to keep a copy of the completed form and enclosures for your own records.

NOTE: Applications submitted in hardcopy, by fax, disk or e-mail will not be accepted. You may only apply online.

Reducing Bureaucracy (This section does not apply to applicants based outside Northern Ireland)As part of Government’s Reducing Bureaucracy programme you are required to upload a number of master documents to the Government Funding Database.  Some organisations in receipt of Arts Council Exchequer funds are already registered with this database and have a Unique Reference Number; others will be required to register prior to the application being assessed.  Once uploaded these documents will exist for all applications you make to any Government Department and you will not be required to submit them with individual applications, including future applications to the Arts Council. 

If you are not currently on the Database you will be required to register at https://govfundingpublic.nics.gov.uk/Home.aspx

Full instructions for uploading documents to the Government Funding Datasbase are available for download from the Arts Council’s website:   http://artscouncil-ni.org/funding/scheme/lottery-project-funding-2017-18

3

APRIL 2017

NOTES TO HELP YOU COMPLETE THE APPLICATION FORM

This section is designed to help you fill in each of the questions on the online application 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 One – 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 details for the person named at (3) are not as those given at (2) above, then please provide appropriate contact details here.

Section Two – Organisation Details

A. If you have received an award since 1st April 2011 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 and 9.

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. If you have indicated that your organization is a recognized charity, you must provide your NI

Charity Number if you are based in Northern Ireland, or your Great Britain Charity Number if you are based in GB. If you are not registered as a charity but have a Company Unique Taxpayer Reference from HMRC, you must provide it here.

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 2011 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 2011.

9. You MUST complete this section. If you are registered with Access NI, state your registration details; if you are registered with an umbrella body, state its name.

4

APRIL 2017

Section Three – 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 our Council, to the public and in any reports or publications linked with this programme. You must also provide the proposed start and end dates of your project.

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 8 – 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. If there is more than one artform please list a maximum of 3 artforms in order of importance (1 being the most important).

3. Indicate if your project meets any of the programme aims, and list the ward areas which you will target in socially disadvantaged areas if they include any of the 20 most deprived wards listed in the table and in the guidance notes.

4. If you are in receipt of an award under the Council’s 2017/18 Annual Funding Programme, please describe why this project is of an exceptional nature and why it was not anticipated at the time of your 2017/18 application.

5. You only need to complete this question if you are applying for premium payments costs.You should indicate which Section 75 group you will be targeting with the premium payment amount and the specific number of people that the premium payment will benefit.

Section Four - Finance

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 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.

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.

5

APRIL 2017

Section Five – Equality of Opportunity and Good Relations Commitment

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.

Section Six – Equality Monitoring

The information in this section must be completed. It will not form part of any assessment process, but will be used by the Arts Council for statistical gathering purposes.

Section Seven – Child//Young People/Adults at Risk Protection Policy Statement

Organisations   that   work with children, young people and adults at risk need to ensure that their Safeguarding systems and Procedures adhere to best practice.  Please see the information below to consider in relation to your own organisation’s procedures.

It is a requirement of our funding that any organisation which comes into contact with children, young people and adults at risk, either directly through its programmes or indirectly through its services, must commit to a Safeguarding Policy which must have been formally agreed by your organisation.

If your Safeguarding 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. If you are successful in obtaining a grant, the Arts Council may, as part of its monitoring processes, ask to see these documents during the incoming year.

6

APRIL 2017

Section Eight – Enclosures

Government Funding DatabaseIf you are based in Northern Ireland, the following documents MUST be uploaded to the Government Funding Database at https://govfundingpublic.nics.gov.uk/Home.aspx  

Constitution and/or Memorandum and Articles of Association Most recent set of Audited/Certified/adopted accounts. Organisation Chart List of office bearers Rental Agreement/Lease of Evidence of ownership

If you are based outside Northern Ireland you MUST upload the 5 documents listed above AND all the documents listed in the table in Section Eight to the Arts Council at the time of submitting your on-line application.

All applicant organisations must upload and submit the following mandatory enclosures with their applications:

1) Detailed Project Description: If you are seeking between £10,001 and £50,000 your project description should be no more than 2,500 words. For projects seeking over £50,001 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: Locations and dates 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 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 a 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.

2) 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.

7

APRIL 2017

Criterion 1: Public benefit (200 – 500 words)1) Describe how your project contributes to the Arts Council’s artform

strategy and/or policy priority.2) Describe how your project contributes to the growth of the arts in the

community for new and existing audiences, and how it reflects the diversity of Northern Ireland society and culture.

3) Describe your project’s marketing strategy.

Criterion 2: Quality of arts activities planned, including how closely the activity is linked to the Council’s artform policies (200 – 500 words)4) Describe how your project offers creative vision and imaginative

programming.5) Describe your project’s production/performance/ presentation/facilitation

and process

6) Give details of the artists and facilitators who will be involved with your project.

Criterion 3: Organisational and Project Viability, including how you have managed previous projects (200 – 500 words)7) Describe how you have planned your project. 8) Describe how your organisation is governed, including details of how often your board meets, reporting mechanisms, sub-committees and training.9) Describe how your organization manages its finances.

3) 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 itemize expenditure wherever possible (example: “Annual rent £12,000” is acceptable but “Salaries £100,000” must be broken down to give specific details). 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;

8

APRIL 2017

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.

4) 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.

5) Applicants are required to upload a copy of their organisation’s most recent Audited/Certified/Adopted Accounts to the Government Funding Database. If the accounts uploaded to the GFD are not for the year 2016/17, (ie, if your most recent audited accounts are for the 2015/16 financial year), we require a set of management accounts covering the intervening period, up to March 2017. 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.

6) 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 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.

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

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

9

APRIL 2017

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: ________________________________

10

APRIL 2017

SECTION TWO - ORGANISATION DETAILS

Please note: If you have received a grant from the Arts Council since 1st April 2011: 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? ()

Please tick all that apply

Please give charity number

Unincorporated club or associationCompany limited by guaranteeCompany limited by sharesRecognised charity (by HMRC)*Registered charity (by NI Charities Commission)TrustOther: Please specify below

* If you are not registered as a charity in NI or GB, but have a Company Unique Taxpayer Reference from HMRC, please input it here. (You do not have to provide this if you have provided your Charity Number)

4. VAT Registration Number (if applicable) _______________________

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

Name _________________________ Position ______________________________

Name _________________________ Position ______________________________

Name _________________________ Position ______________________________

11

APRIL 2017

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

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

8. 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

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

12

APRIL 2017

SECTION THREE – PROJECT DESCRIPTION

1.1 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 8 – Enclosures).

1.2 Project Start Date: __________________________

1.3 Project End Date: __________________________

13

APRIL 2017

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 Council’s stated programme aims? (tick )

a) Encourages the involvement of children and young people, older people, or people with disabilities with organisations and artists of the very highest professional standards across the disciplines

b) Promotes innovative, original work by Northern Ireland artists, especially in drama and dance, which tours outside the company’s administrative base

c) Advances collaborative audience development projectsd) Promotes intercultural dialogue

4. If you are in receipt of an award under the Council’s 2017/18 Annual Funding Programme, please describe why this project is of an exceptional nature AND why it was not anticipated at the time of your 2017/18 application. (200 words max. See page 5 of the Guidance Notes.)

14

APRIL 2017

If you are applying for premium payments costs within this application, please answer the 2 questions below. If not, proceed to Section 4 Finance.

5. Which of the following Section 75 categories do you intend to engage with/target if you are successful in receiving a premium payment allocation within your grant; and how many people to you anticipate engaging in the project as a direct result of the premium payment.

Premium Payment is designed to meet the additional costs associated with delivering projects for people with particular needs as defined under Section 75 of the Northern Ireland Act. Which Section 75 group(s) will the Premium Payment enable you to target? Section 75 group Number of

direct beneficiaries

MenWomenReligious belief (e.g. community relations)Political opinionRacial Group (e.g. people from ethnic minorities)Older People (aged 65+)Children / Young People (0 to 24 years)Marital status (e.g. lone parents)Sexual orientation (e.g. Lesbian, Gay, Bisexual, Trans and Queer)People with physical disabilities (including sensory impairments)People with mental health conditionsCarer (e.g. person with responsibility for child, disabled person, older person)

What will the Premium Payment be used for?

Adapted transportParticipant/audience transport costsArtists’ travel costsChildcareOutreachCompanion supportPublication in different languagesLarge print / brailleAudio describedInduction loopCaptioningRelaxed performancesWheelchair accessOther, please specify belowTickets (complimentary or concession)Other: (specify)

15

APRIL 2017

SECTION FOUR – FINANCE

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 £ Amount sought from Arts Council

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 Lottery)* SponsorshipFeesProgramme salesOther (Please specify)

TOTAL INCOME

16

APRIL 2017

5. Please list below the individual funders included in the *Grants (non-Arts Council Lottery) 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

17

APRIL 2017

SECTION FIVE - EQUALITY OF OPPORTUNITY and GOOD RELATIONS COMMITMENT

It is a requirement of the funding conditions under this programme that your organisation commits to equality of opportunity and good relations duty.

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.

The applicant organisation recognises these obligations and undertakes not to act in any way, which would contravene the Arts Council’s statutory duty. The organisation confirms its commitment to the principles of affording equality of opportunity in all aspects of the organisation’s activities, in particular with regard to access and participation in these activities.

It is the organisation’s intention to ensure equal opportunity for all job applicants and employees and to eradicate direct or indirect discrimination.

It is also the organisation’s 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.

18

APRIL 2017

SECTION SIX - 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 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.

The main group to benefit will be: 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

19

APRIL 2017

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

7. Marital Status

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

20

APRIL 2017

8. Sexual Orientation

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

9. Age

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

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

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

10. Persons with a 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

Does the Board/Management committee mainly comprise: Please () one box onlyPeople with a DisabilityPeople without a DisabilityPeople with a Disability and People without a Disability(where neither community is over 60%)

11. Men and Women

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

12. Persons with 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.

Does the Board/Management committee mainly comprise: Please () one box onlyPeople with dependants

21

APRIL 2017

People without dependantsPeople with dependants and people without dependants(where neither community is over 60%)We are unable to specify

13. Religious Belief

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

14. Political Opinion

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

15. Racial Group

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

22

APRIL 2017

16. Marital Status

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

17. Sexual Orientation

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

18. Age

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

23

APRIL 2017

SECTION SEVEN:  CHILD / YOUNG PEOPLE / ADULTS AT RISK PROTECTION POLICY STATEMENT

Organisations   that   work with children, young people and adults at risk need to ensure that their Safeguarding systems and Procedures adhere to best practice.  Please see the information below to consider in relation to your own organisation’s procedures.

It is a requirement of our funding that any organisation which comes into contact with children, young people and adults at risk, either directly through its programmes or indirectly through its services, must commit to a Safeguarding Policy which must have been formally agreed by your organisation.

If your Safeguarding 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. If you are successful in obtaining a grant, the Arts Council may, as part of its monitoring processes, ask to see these documents during the incoming year.

Statement of commitmentThe applicant organisation is committed to practice which protects children, young people and adults at risk from harm. Staff, volunteers and artists in this organisation accept and recognise their responsibilities under the Children (NI) Order 1995, Co-operating to Safeguard Children  DHSSP 2003, Safeguarding Vulnerable Groups (Northern Ireland) Order 2007 and Safeguarding Vulnerable Adults – A Shared Responsibility 2010  and will endeavour to carry these out by:

having an awareness of the issues which cause children, young people and  adults at risk from harm;

adopting Safeguarding protection guidelines for staff, leaders, volunteers and artists; providing information about Safeguarding and good practice to children, young people, 

adults, primary carers, staff, volunteers and artists; sharing information about concerns with those 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 Safeguarding  policies and procedures under regular review; and providing information as required to management committees/funders.

24

APRIL 2017

SECTION EIGHT – ENCLOSURES

Applicants based outside Northern Ireland are not required to upload documents to the Government Funding Database.  If you are based outside Northern Ireland you MUST upload the 5 documents listed below AND all the documents listed in the tables directly to the Arts Council at the time of submitting your on-line application.

If you are based in Northern Ireland, the following documents MUST be uploaded to the Government Funding Database at https://govfundingpublic.nics.gov.uk/Home.aspx   Constitution and/or Memorandum and Articles of Association Most recent set of Audited/Certified/adopted accounts. Organisation Chart List of office bearers Rental Agreement/Lease of Evidence of ownership

Failure to upload documents to the Government Funding Database or attach any of the required documents to this application will result in your application being ineligible.

THE FOLLOWING DOCUMENTS MUST BE ATTACHED AND UPLOADED TO THE ON LINE SYSTEM WITH THIS APPLICATIONOnline applications may be edited, saved and returned up to the closing date. You MUST submit ALL mandatory enclosures associated with the application at the same time, ie. at the point at which you submit your online application. All documents must be in Word, Excel or pdf format. We cannot accept documents in other formats. Total size of documents should not exceed 25 Mb.

Please tick if uploaded

Document

1) Detailed description of THIS project (see Guidance Notes and page 7 of this sample application document)

2) Description of how your project meets the programme criteria (See Guidance Notes and page 7 and 8 of this sample application document)

3) 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. (example: “Annual rent £12,000” is acceptable but “Salaries £100,000” must be broken down to give specific details) 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).

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

5) If the accounts uploaded to the Government Funding Database are NOT for 2016/17 then you MUST attach management accounts as at 31 March 2017.

6) Details of premium payment costs, if applicable

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

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

25

APRIL 2017

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.

26

APRIL 2017

SECTION NINE - 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 Applicant’s Statement in the online 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.

27

APRIL 2017

SECTION TEN - APPLICANT’S STATEMENT

You MUST tick the box below to indicate that you have read and agree the following statements:

I confirm that I am authorised to submit this application.

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

I confirm that the organisation has adopted the Safeguarding Children/Young People/ Adults at Risk Protection Policy Statement and the organisation’s child protection policies are not more than 3 years old.

I confirm that the organisation has adopted the Equality of Opportunity and Good Relations Commitment.

I confirm that the organisation accepts the use of the data supplied with this application form as outlined in the statement of Publicity, Openness and Accountability.

I confirm that any Management Accounts supplied in conjunction with this application have been approved by the appropriate board or committee and are a true and accurate record of the organisation’s finances.

I understand that the information provided on this form may be made available to other departments/agencies for the purposes of preventing or detecting fraud.

I understand that if I have deliberately given any false or misleading information, the Arts Council will withdraw this application or, if a grant has already been awarded, ask for repayment of any funds already paid. This will also have implications for any future applications the organisation may submit.

I confirm that the following documents held on the Government Funding Database are the most up to date and fit for purpose for this application.

o Copy of Constitution/Memorandum of Associationo List of office bearerso Organisation Charto Copy of Audited/Certified/Adopted Accountso Rental Agreement/Lease or evidence of ownership

I have attached all the listed enclosures required for submission in conjunction with this application.

I have read and agree the above statements

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

28