SSNO Application Form 2016 - Pobal Web viewApplication Form. 2016-2019. Introduction. ... Organisation chart of the national organisation which illustrates how the staff post(s)

Application Form2016-2019

IntroductionPrior to completing the application form, applicants should read the Applicant Guidelines which have been developed to support organisations who wish to apply for SSNO funding (2016-2019). Applicants should pay particular attention to the Eligibility and Selection Criteria in section 8.

Things to know about completing the application form:

You can download the application form from the Pobal Website (wwwpobal.ie) The application form is in Microsoft Word format. The questions in the application form have a maximum character limit imposed for your

response and this is illustrated by the size of the textbox for each question i.e. the text box size indicates the maximum amount of information that you can include in your response. Please note: only the information that is visible within a textbox will be taken into account when appraising your application.

The default font/text size in this form is Arial 11. This is the minimum text size you should use (with the exception of the budget explanations in Q4.4 which are set to Arial 9).

If you wish to provide further information to support your application, there are an additional two pages included in section 6 of the form. Please clearly indicate the question number that the additional information corresponds to.

In answering a question, you may include a hyperlink to a specific document of relevance that is contained on your organisational website. It is important to ensure that the correct hyperlink is provided so that the document can be accessed.

The Budget Template at Q4.4 has automatic totals for each section of the budget. Please ensure that when you enter a value in the table you click into a different numeric cell in the same table to refresh the totals. This is particularly important in the last cell of each table.

Submitting the application form:

Prior to the submission of the completed application form, please refer to the Checklist for Applicants detailed in section 8 of this form.

Save your final completed form as Word Document – please do not PDF. The completed application form and all supporting documentation must be submitted via

email to: [email protected]

Please put your organisation’s legal name in the subject line of the e-mail.

Upon submission of your application you will receive an automated e-mail response from the SSNO mailbox. If you do not receive an automated response please contact us immediately. The onus is on the applicant to ensure that the application is received by Pobal by the closing date.

Closing date: Monday 08th February 2016 at 12 noon

mailto:[email protected]

1.1 Legal Name:

1.2 Business Name (if different from above):

1.2 Address:

County:

EIRCODE:

Telephone:

Email:

Website:

1.3 Choose an item.Organisation Type:

1.4 Company Registration Number:

YES1.6 Is your organisation registered for VAT?

1.7 Tax Registration Number (TRN):

1.8 Tax Clearance Access Number (TCAN):

1.9 Pobal URN (if applicable):

1.10 Primary Contact for your SSNO Application:Name: Title MissFirst Name and Last Name

Position: Position

Telephone: Tel Email: Email

1.11 Chairperson Contact:Name:

Telephone: Email:

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Section 1: Applicant Details

Complete as per your Governing Document

Business Name

Address1Address2

Select County

Eircode

Telephone

Email

Website

Choose an item.

CRO

Choose Yes or No

TRN

TCAN

Six digits and a letter

Title MissFirst Name and Last Name

Tel Email

2.1 Provide a concise overview of the work of your organisation, including the main aim and key activities.

Click here to enter text.

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Section 2: Your Organisation

2.2 Outline the impact of the work of your organisation in relation to one (or more) of the following, highlighting the most recent achievements and future plans in this regard:-

addressing poverty social exclusion promoting equality


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2.3 Complete the following table in relation to your organisation:

Number of individuals who are registered as members of your organisation (if applicable): Click here

Number of member/affiliated organisations who are registered with your organisation (if applicable): Click here

Number of individuals that you provide representation for or advocate on behalf of (if applicable) Click here

2.4 Outline the national reach and impact of your organisation in relation to the extent of your engagement with member groups and/or individuals and the level of supports/services provided nationally.


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2.5 (a) Outline the current staffing structure and staff reporting mechanism within your organisation.


(b) How many staff (full time equivalents) are currently employed in your organisation?

FTEs (full time equivalents) FTEs

(c) Please attach your current organisational chart or organogram which includes the core staff posts that form the basis of your SSNO application.

Organisational Chart Attached Choose Yes or No

YES

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2.6 Provide a summary of relevant Exchequer, EU or philanthropic funding that your organisation has been awarded and directly managed over the previous 2 years.

YearAwarded

Funder Programme

Amount Awarded

€

Highlight any significant issues in relation to the delivery or

management of this fundingYear Funder Programme Amount Issues

Year Funder Programme Amount Issues




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3.1 Provide details of the current governance arrangements of your organisation in relation to the following:

a) Board composition and size, highlighting relevant skills and expertise of Board Members.


b) Board structure and management committees e.g. provide details on any sub-committees or advisory boards and their purpose.

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Section 3: Governance Arrangements


c) Frequency of Board meetings and Board reporting structures


d) Any Governance Codes or good governance standards that your organisation has adopted or is in the process of putting in place.

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e) Financial Management i.e. provide details of the specific procedures and controls in place within your organisation to ensure good financial management, including the management of reserves.

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f) Risk Management: Highlight the Board’s strategies to deal with any financial and operational risks that are relevant to your organisation e.g. provide details of any risk registers, risk management framework/strategy or other risk management tools that are implemented by the Board.

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3.2 Attach a copy of your organisation’s Memorandum and Articles of Association/ Governing Document. This is non-applicable if you are currently in contract with Pobal and have made no recent changes to your Governing Document.

Memorandum and Articles of Association/ Governing Document Attached

Choose Yes or No

YES

3.3 Attach a copy of your organisation’s signed Annual Financial Statements (AFS) for 2014. If your organisation is currently in contract with Pobal and you have already submitted a signed copy of the AFS for 2014 there is no requirement to resubmit.

Annual Financial Statements (AFS) for 2014 Attached

Choose Yes/No/Not Required

YES3.4 Attach a copy of your organisation’s most recent set of Management Accounts for 2015

or Year End Accounts 2015, which have been approved by the Board.

Management Accounts for 2015 or Year End Accounts 2015 Attached

Choose Yes or No

YES

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Section 4: Request for SSNO Funding

4.1 State exactly what you are requesting SSNO funding for over the duration of the funding period, i.e. core salary, direct and indirect organisation costs. Your response must explain how the staff positions and costs requested are “core” to the operation and continued existence of your organisation.


4.2 Provide the following information in relation to the core salary costs that you have requested funding for under SSNO.

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Job Title % of Salary requested from SSNO Approx. Hours Contracted per

Week 2016

Jul-Dec2017 2018 2019

Jan-Jun

Click here to enter text. % 2016 % 2017 % 2018 % 2019 Hrs




4.3 Please attach Job Descriptions for all posts applied for under SSNO.

Job Descriptions Attached Choose Yes or No

YES

4.4 Complete the budget template sheets overleaf in relation to the costs applied for under SSNO. If your organisation is registered for VAT please ensure that VAT is excluded when completing the budget template.

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SSNO Budget Template

Direct Costs

Salary (A) 2016Jul-Dec

2017 2018 2019Jan-Jun

Total Explanations

IMPORTANT: EACH TIME YOU ENTER A VALUE IN ANY OF THE NUMERIC CELLS IN THE TABLE BELOW, PLEASE CLICK INTO A DIFFERENT NUMERIC CELL IN THIS SAME TABLE BELOW TO REFRESH THE TOTAL.

€ € € € €Insert Job Title 0 Detail, for example, salary scale/ benchmark applied

Insert Job Title 0 Detail, for example, salary scale/ benchmark applied




Employers PRSI 0

Pensions 0 Enter details of Employer Contribution, if applicable

Travel and Subsistence

0 Detail, for example, T&S rate and rationale for level of funding requested

Training and Development

0 Enter Explanation

Recruitment 0 Enter Explanation

Total Salary Costs (A)

0 0 0 0 0

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IMPORTANT: EACH TIME YOU ENTER A VALUE IN ANY OF THE NUMERIC CELLS IN THE TABLE BELOW, PLEASE CLICK INTO A DIFFERENT NUMERIC CELL IN THIS SAME TABLE BELOW TO REFRESH THE TOTAL.

Non-Salary (B) 2016Jul-Dec

2017 2018 2019Jan-Jun

Total Explanations

€ € € € €Insert cost heading 0 Provide details of the cost; e.g. basis and justification

Insert Cost Heading 0 Provide details of the cost; e.g. basis and justification

Insert Cost Heading 0 Provide details of the cost; e.g. basis and justification

Total Non-Salary Costs (B)

0 0 0 0 0

Total Direct Costs (A+B)

0 0 0 0 0

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Indirect Costs

IMPORTANT: EACH TIME YOU ENTER A VALUE IN ANY OF THE NUMERIC CELLS IN THE TABLE BELOW, PLEASE CLICK INTO A DIFFERENT NUMERIC CELL IN THIS SAME TABLE BELOW TO REFRESH THE TOTAL

Indirect Costs

(C)2016

Jul-Dec2017 2018 2019

Jan-JunTotal Explanations

€ € € € €Insert Cost Heading 0 Enter details of the cost; basis and justification

Insert Cost Heading 0 Enter details of the cost; basis and justification

Insert Cost Heading 0 Enter details of the cost; basis and justification

Total Indirect Costs (C)

0 0 0 0 0

Budget Summary

Total Budget Applied for

(A+B+C)

0 0 0 0 0

% Flat Rate Overheads

(Total C/Total A+B)

**Express

ion isfaulty **

**Express

ion isfaulty **

**Expressi

on isfaulty **

**Expressi

on isfaulty **

**Expressi

on isfaulty **

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5.1 Explain how the core costs (i.e. core salary, direct and indirect organisation costs) now requested under SSNO are currently funded and when this funding is due to end.


5.2 If your organisation currently has reserves please provide the following information as per the signed Annual Financial Statements for 2014?

Amount of Restricted Reserves

€ Click here to enter text.

Amount of Unrestricted Reserves

€ Click here to enter text.

Outline any specific plans for the Unrestricted Reserves during the funding period


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Section 5: Need for Core Funding

5.3 Outline how the SSNO funding, if awarded, will contribute to the continued existence of your organisation and its current activities, including the achievement of your organisations objectives (goals) during the funding period.


5.4 Explain how the funding requested under SSNO represents value for money?


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5.5 Explain what would be the impact on your organisation if you did not receive SSNO funding?


5.6 Please provide any additional information which you believe is relevant in demonstrating the need for the funding requested.


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You may include any further information to support your application in the following two pages. Please clearly indicate which question in the application form the information corresponds to.


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Section 6: Additional Information


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Please read carefully

By submitting the application, the Board of Directors/Management Board declare that the information provided in relation to the organisation described in this application is true and complete to the best of their knowledge and belief.

The Board of Directors/Management Board acknowledges that any funds awarded must be used for the purpose stated and not used to replace existing funding. The Board also understands that information supplied in, or accompanying, this application may be made available on request under the Freedom of Information Acts 2014

The Board accepts, as a condition of the award of a grant, that it involves no commitment to any other grants from The Department of the Environment, Community and Local Government or Pobal. The Board are agreeable to having the project monitored by Pobal and The Department of the Environment, Community and Local Government and to allow access to premises and records, as necessary, for that purpose.

The Board of Directors/Management Board also accepts that Pobal may contact Funder Organisations or Government Departments to discuss this application and previous funding awarded, as part of the appraisal process.

Disclosure under the Freedom of Information Act

The Department of the Environment, Community and Local Government wishes to remind applicants that the information contained in the application form and supporting documentation may be released, on request, to third parties, in accordance with the Department’s obligations under the Freedom of Information Act 2014.

You are asked to consider if any of the information supplied by you in applying for funding under the Scheme to Support for National Organisations (SSNO) should not be disclosed because of sensitivity. If this is the case, you should, when providing the information, identify same and specify the reasons for its sensitivity. The Department of the Environment, Community and Local Government and/or Pobal will consult with you about sensitive information before making a decision on the release of such information. The Department of the Environment, Community and Local Government and/or Pobal will release, on request, information to third parties, without further consultation with you, unless you identify the information as sensitive with supporting reasons.

If you consider that some of the information is sensitive, you are required to clearly identify such information when submitting your application.

If you do not identify any of the information supplied in the Application Form and supporting documentation as being sensitive you are acknowledging that any, or all of the information supplied, will be released in response to a Freedom of Information request.

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Section 7: Disclaimers

Disclaimer

Please read carefully:

It will be a condition of any application for funding under the terms and conditions of the Scheme to Support National Organisations.

i. The Department of the Environment, Community and Local Government and Pobal shall not be liable to the applicant or any other party in respect of any loss, damage or costs of any nature arising directly or indirectly from:

a) the application or the subject matter of the application;b) the rejection for any reason of any application.

ii. The Department of the Environment, Community and Local Government, its servants or agents shall not at any time in any circumstances be held responsible or liable in relation to any matter whatsoever arising in connection with the development, planning, construction, operation, management and/or administration of individual projects.

By submitting this application the Board of Directors/Management Board acknowledges that they have read, understood and accepted the above points.

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You should ensure that the following information is provided when submitted your application:

Applicant ChecklistFully completed official SSNO Application Form

☐ A copy of the organisation’s Governing Document (Memorandum and Articles of Association). N/A if your organisation is currently in contract with Pobal and you have not changed your Governing Document recently

☐ A copy of the organisations signed Annual Financial Statements for 2014 (if not already submitted to Pobal)

☐ A copy of the organisations most recent set of Management Accounts for 2015 signed by the Board or the signed Annual Financial Statement for 2015

☐ Job Descriptions for each staff post applied for under SSNO

☐ Organisation chart of the national organisation which illustrates how the staff post(s) which form the basis of the SSNO application are a core post

The completed Application Form and supporting documentation must be submitted by email to:

ss no@pob a l . ie

b y Monday 08 th February 2016 at 12 noon

For further information or queries please email: [email protected]

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Section 8: Checklist for Applicants

Documents

SSNO Application Form 2016 - Pobal Web viewApplication Form. 2016-2019. Introduction. ... Organisation chart of the national organisation which illustrates how the staff post(s)