ARTS COUNCIL OF NORTHERN IRELAND NATIONAL LOTTERY PROGRAMME NORTHERN IRELAND MUSIC TOURING PROGRAMME APPLICATION FORM

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1 ARTS COUNCIL OF NORTHERN IRELAND NATIONAL LOTTERY PROGRAMME NORTHERN IRELAND MUSIC TOURING PROGRAMME APPLICATION FORM Application round opens Deadline for Receipt of applications Decisions 25 January pm, 18 February 2016 March 2016 This application round is for projects which will be completed by 31 March Please read the Guidance Notes carefully before you complete this application form. If you need assistance to complete this application form please contact the Arts Council s Arts Development Department on

2 GUIDANCE ON HOW TO COMPLETE THE APPLICATION FORM FEBRUARY 2016 Introduction Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Section 8 Notes to help you complete the application form Contact details Organisation details Project Description Finance Equality of Opportunity and Good Relations Commitment and Child/Young People/Adults at Risk Protection Statement and Safeguarding Checklist Enclosures Publicity, Openness and Accountability Applicant s Statement Applicants are advised to read the full 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. Hard Copy Application The application form may be typewritten or handwritten. If handwritten, it should be completed in block capitals and black ink. The Arts Council reserves the right to reject applications which it cannot read. The form may also be completed by reproducing the questions, with answers, on your own word processing system. If you choose to submit an application, ALL documentation must be supplied in hard copy at the time of submission, which must be before the 4pm deadline on the programme closure day. Note: The Council will not accept applications by . 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 Funders 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 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. 2

3 The Lottery Distributors share information with each other to enable them to detect fraudulent applications and to co-ordinate processing of complementary applications. It may also be used by the Department for Culture, Media and Sport and 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. Please complete and return the application form and enclosures. The form must have an original signature if submitted in hard copy. All applications must be received by 4.00 pm on the closing date. NOTE: it is your responsibility to ensure that the Arts Council receives the application form and documents by the closing date within the required timescale. You should also note that proof of postage is not proof of delivery. The Arts Council accepts no responsibility for applications/documents which are delivered late by the Post Office or other carriers. Completed forms should be sent to: Arts Council of Northern Ireland, Arts Development Department, 1 The Sidings, Antrim Road, LISBURN, BT28 3AJ NOTE: Applications cannot be submitted by fax, disk or . Submissions must be in hard copy. REMEMBER TO KEEP A COPY OF THE APPLICATION FORM AND ENCLOSURES FOR REFERENCE. 3

4 INTRODUCTION This section is designed to help you fill in each of the questions on the form. Please refer to them as you complete each question, as the detail we require may be different from that which you have provided us with on any previous application. Section 1 Contact details 1. This must be the same name as that on your Constitution, and on your Bank Account 2. This is the address and details of the organisation s headquarters or the place where your organisation meets 3. The name of the person who can be contacted during working hours and who is authorised to answer all questions relating to this application on behalf of the organisation. Please ensure that this person is going to be available and is not away on business/ holiday during the period that the application is being assessed. The Arts Council will not accept responsibility for missing information or misinterpretation of the form where the contact person has not been available at any of the contact details given. 4. Is this person the chairman, treasurer, secretary or do they hold another position within the organisation 5. If the contact person does not work at the address given at (2) above, then please give other contact details. Section 2 Organisation Details A. If you have received an award since 1 st April 2010 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 incorporation 3. Most clubs and societies are unincorporated. 4. Unless you are an organisation with a base in Great Britain where charities are registered, the Inland Revenue in Northern Ireland recognises organisations as having a charitable purpose. You should quote here your Inland Revenue reference number, if you have one. 5. If you are VAT registered you should quote your reference number here. The Arts Council will not pay VAT incurred by VAT registered organisations. 6. You should complete this section with the names of the Chairman, Secretary and Treasurer or the equivalent committee positions in your organisation 7. You should give the total number of staff of who have been in permanent employment since April 2010 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 If you are successful in obtaining a grant, payments will be made directly into your bank/building society account. Please ensure these details are correct. 10. 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

5 Section 3 Project Description 1. Give a description of the activity you are asking us to support in no more than 100 words. We will use this to decide who should assess your application and also to present a short outline of your project to our Council, to the public and in any reports or publications linked with this programme. You are also required to supply an additional full description of your project, as well as a detailed description of how your overall programme meets each of the programme criteria (see page 5 and page 13). 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. Section 4 - 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

6 Section 5 Equality of Opportunity, Good Relations Commitment, Child/Young People/Adults at Risk Protection and Safeguarding Checklist FEBRUARY 2016 It is a requirement of the funding conditions of all Arts Council of Northern Ireland programmes that your organisation commits to equality of opportunity and good relations duty. Therefore, this Statement MUST be adopted by your organisation. It is a requirement of ACNI s funding conditions that an organisation which comes into contact with children, young people and adults at risk, either directly through its programmes or indirectly through its services, commits to a Safeguarding Policy. Therefore, this Statement MUST be adopted by your organisation if any aspect of your work is aimed at children, young people and/or vulnerable people. Due to changes in Government legislation, all organisations dealing with children, young people and adults at risk MUST complete and return the Safeguarding Checklist. This document is additional to the organisation s child protection policy. The document must have been agreed by your organisation and should be signed and dated. If you are unable to tick all boxes as yes at the time of submitting the application, you must take steps to address all the issues prior to drawdown of any awarded funds. Government has issued guidance that no funds should be paid across to organisations until they are able to sign up completely to the checklist. Section 6 Enclosures and uploads to the Government Funding Database If you are based in Northern Ireland, the following documents MUST be uploaded to the Government Funding Database at (See notes on page 2 of this application form.) 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 Applicants based outside Northern Ireland are not required to upload documents to the Government Funders Database. If you are based outside Northern Ireland you MUST send the 5 documents listed above AND all the documents listed below directly to the Arts Council at the time of submitting your application. Failure to upload documents to the Government Funding Database or to supply any of the required documents along with your application will result in your application being ineligible for assessment. Additional enclosure documents to be submitted with your application: 1) Copy of your Equal Opportunities Policy: This policy document must be signed and dated as adopted. 2) Copy of your Child Protection Policy: This policy document must be signed and dated as adopted. 3) You must provide a memorandum of understanding between the promoter and the venue for all tours (template provided on website) 6

7 4) You must submit a detailed Marketing and Audience Development Plan to support all tours. 5) Detailed Project Description: If you are seeking up to 25,000 your project description should be no more than 2,500 words. For projects seeking over 25,001 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: Start and finish dates of the tour; Locations of all events within the tour; Names of artists, for each event; 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. 6) Detailed description of how your overall programme meets each of the Programme criteria as detailed below: Identify and address each criterion (including all sub-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. Criterion 1: Public benefit ( words) Describe how your project contributes to the Arts Council s music strategy. 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. Describe your project s marketing strategy. Criterion 2: Quality of arts activities planned ( words) Describe how your project offers creative vision and imaginative programming. Describe your project s production/performance/ presentation/facilitation and process Describe how your project has the ability to support artists, performers and facilitators. 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 ( words) Describe how you have planned your project. Describe how your organisation is governed, including details of how often your board meets, reporting mechanisms, sub-committees and training. Describe how your organization manages its finances. 7) You should provide a detailed income and expenditure budget for EACH project. You must include a breakdown of any budget line over 1,000 and itemize expenditure wherever possible. You should also include details of how you have calculated any fees you are paying, e.g. hourly/daily/weekly rates. Where box office or programme/book sales are shown you should include details of pricing and numbers of tickets/publications to be 7

8 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; and, free access to other services. In-kind funding does not include the time given by your committee or board members to carry out their regular duties If you are including in-kind support to your project you MUST demonstrate how you have calculated this. The Arts Council accepts: the equivalent of the hourly minimum wage for members of the public and young people contributing time as described above; a limit of 120 a day for professionals and/or consultants and employees volunteering their time; the costing by the supplier for the use of premises, equipment and other services You cannot include the costs of employing committee/board members of directors of the organisation to work on the project as research shows that the public regard this as inappropriate use of Lottery funds which are to be used for wider public benefit rather than private gain. You cannot include the costs of gratuitous hospitality or alcoholic beverages. The only hospitality costs we will pay for are where they are integral to the project, for example, an arts conference where lunch is provided to delegates. 8) 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. 9) As noted above, you are required to upload a copy of the organisation's certified or audited accounts to the Government Funding Database. If the uploaded accounts are not for the 2014/15 financial year, you must also provide your most recent set of management accounts (signed and dated as adopted), for the period up to 31 March 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 crèche facilities. 8

9 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) You must provide a list of your organisation s current board members, which details any relevant specialism each brings to the role. 9

10 SECTION ONE - CONTACT DETAILS 1. Name of Organisation: 2. Address of Organisation: Town Postcode Phone number: Fax Number: 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 Phone number: Postcode: Fax Number: address: 10

11 SECTION TWO - ORGANISATION DETAILS (Please note: If you have received a grant since 1 st April 2010: 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 association Company limited by guarantee Company limited by shares Recognised charity Trust Local Authority Other: Please specify 4. Recognised Charity Number (if applicable) 5. VAT Registration Number (if applicable) 6. Please list the names and positions of the 3 main office-holders in your organisation: Name Position Name Position Name Position 7. How many permanent paid staff (if any) work for your organisation? 8. How many volunteers including committee or board members are involved in your organisation? 11

12 9. Name of Bank/Building Society Address Town Postcode Account Name Account Number Sort Code Is your organisation: (a) Registered with Access NI? Yes No If Yes, please give: Date of Registration Access NI Registration Number Name of Lead Signatory for Registration OR (b) Registered with an umbrella body in order to obtain Access NI checks? Yes No If Yes, please give name of umbrella body. OR (c) If The Organisation is not registered in either case above, please provide a statement detailing why this is the case. 12

13 SECTION THREE PROJECT DESCRIPTION 1. Please describe the project for which you are seeking funding in no more than 100 words to include list of touring venues. This description will be presented to Council as part of its decision making process. A more detailed project description must also be enclosed (see Section 6 Enclosures). 13

14 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? Artists costs Equipment/materials Publicity/marketing Travel/accommodation Volunteer expenses Transportation Premium costs (costs of delivery to Section 75 groups, eg sign language interpretation) Administrative costs attributable to this project Other: (please specify) Expenditure TOTAL 4. Where is the partnership funding coming from? Source Income Box office * Grants (non Arts Council Lottery) * Sponsorship Fees Programme sales Other (Please specify) TOTAL INCOME 14

15 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 whether cash or in-kind TOTAL 15

16 SECTION FIVE EQUALITY OF OPPORTUNITY, GOOD RELATIONS COMMITMENT, CHILD /YOUNG PEOPLE/ ADULTS AT RISK PROTECTION POLICY STATEMENT AND SAFEGUARDING CHECKLIST With the exception of the Safeguarding Checklist, organisations who have submitted 2016/17 Annual Funding Programme applications do not have to complete this section, but must re-affirm their commitment to the principles at Section 8. All applicants must complete and submit the Safeguarding Checklist as part of this application. The Arts Council of Northern Ireland has a statutory duty under the Northern Ireland Act 1998, in carrying out its functions to have due regard to the need to promote equality of opportunity between: Persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation; Men and women generally; Persons with a disability and persons without; and Persons with dependants and persons without. In addition, without prejudice to its obligations above, the Arts Council shall, in carrying out its functions relating to Northern Ireland, have regard to the desirability of promoting good relations between persons of different religious belief, political opinion or racial group. We (name of organisation). recognise these obligations and undertake not to act in any way, which would contravene the Arts Council s statutory duty. We confirm our commitment to the principles of affording equality of opportunity in all aspects of our organisation s activities, in particular with regard to access and participation in these activities. It is also our intention to ensure equal opportunity for all job applicants and employees and to eradicate direct or indirect discrimination. It is also our intention to have regard to the desirability of promoting good relations between: Persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation; Men and women generally; Persons with a disability and persons without; and Persons with dependants and persons without. This Equality of Opportunity and Good Relations Commitment was formally adopted by us on (insert date) Authorised Signature Date Position in Organisation 16

17 CHILD/YOUNG PEOPLE/ ADULTS AT RISK PROTECTION POLICY STATEMENT You are required to complete this section of the application form if you have answered YES to any part of question 10 in Section 2 of this application. 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. 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 will be required to 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. 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 commitment The 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. This Child/Young People/Adults at Risk Protection Policy statement was formally adopted by us on (insert date) Authorised Signature Date Position in Organisation... 17

18 SAFEGUARDING CHECKLIST Due to changes in Government legislation, all organisations dealing directly with children, young people and adults at risk MUST complete and return the Safeguarding Checklist. This document is additional to the organisation s child protection policy. The document must have been agreed by your organisation and should be signed and dated. If you are unable to tick all boxes as yes at the time of submitting the application, you must take steps to address all the issues prior to the drawdown of any awarded funds. Government has issued guidance that no funds should be paid across to organisations until they are able to sign up completely to the checklist. Government has also issued best practice guidance which states that all child protection policies should be updated every 3 years. If your organisation s policy is more than 3 years old you are asked to revisit it in the light of current legislation. Organisation Name: Question Types of evidence Yes No Comments Does your organisation have a safeguarding statement agreed by senior management. Copy of statement Statement promoted to stakeholders Does your organisation have written procedures for recruitment and selection of staff and volunteers? Are all staff and volunteer appointments subject to the appropriate safeguarding checks and these are properly recorded. Does your organisation provide access to Safeguarding training for Designated Officer, staff and volunteers? Does your organisation regularly re-evaluate and update your safeguarding training and education? Promoted on web site Written job description Written application form to include request for references and self declaration. Record of interview Follow-up on written references Access NI reference check recorded Written list of roles that are regulated within the organisation Proof of ID request Written list of information provided to staff on induction. Copy of letters/memos/certificate outlining safeguarding training provided to staff. Data-base of those trained Learning outcomes from safeguarding training. Name of designated Safeguarding Officer (Please provide name of body in comments) Copy of letters/memos/certificate outlining Safeguarding training provided to staff. Does your organisation have written procedures for reporting protection concerns, disclosures and allegations? Are the procedures for reporting concerns communicated to staff Written procedures for reporting concerns to Designated Officer and statutory services Pro formas/written guidance. Confirmation from staff (especially recently recruited) 18

19 ,volunteers, children, young people and vulnerable adults? Does your organisation have an open complaints process that includes guidelines on a disciplinary process? Does your organisation have written procedures for Designated Officers? Are the contact details of Designated Officers communicated to staff/volunteers/children / young people and vulnerable adults? Do you have a written Code of Behaviour? Do you have a written Safeguarding policy and procedures, endorsed and approved by Management Board? Do you communicate your Safeguarding policy statement to staff/volunteers/children/ young people/ vulnerable adults and parents? that they have received safeguarding training and written reporting procedures Copy of complaints, disciplinary and appeals process. Evidence of how this is communicated to stakeholders Written documents stating the name and up to date contact details of Designated Officers.(Please name Designated Safeguarding Officer(s)in comments) Written evidence to support that staff, members and volunteers are aware of who to contact and how. Confirmation from staff/volunteers Written Code of Behaviour Evidence this is communicated to all stakeholders Written Policy Statement and associated procedures Please advise when last reviewed and updated. Confirmation from staff/ volunteers/ children/ vulnerable adults and parents that they received a copy or know where to access the policy This Safeguarding Checklist was completed by us on (insert date)... Authorised Signature Date Position in Organisation Please refer to the Arts Council s Child Protection Best Practice Guidelines for Arts Organisations to ensure your own guidelines and policy represent good practice in relation to working with children. Please see the Arts Councils website, from the Home page click on About the Arts then click on Youth Arts. See Publications and Information for a link to the Child Protection Best Practice Guidelines. Protection.pdf 19

20 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: People with a Disability People without a Disability People 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: Women (including girls) Men (including boys) Transgendered people Both women and men (where neither community is over 60%) We are unable to specify which group will mainly benefit 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. The main group to benefit, will be: People with dependants People without dependants People with dependants and people without dependants (where neither community is over 60%) We are unable to specify which group will mainly benefit 20

21 4. Religious Belief The main group to benefit, will be: Protestant Catholic Both Protestant and Catholic communities (where neither community is over 60%) Buddhist Hindu Islam / Muslim Jewish Sikh Other Religious Belief We are unable to specify which group will mainly benefit 5. Political Opinion The main group to benefit, will be: Nationalist generally Unionist generally Other We are unable to specify which group will mainly benefit 6. Racial Group The main group to benefit, will be: Black African Black Caribbean Other Black Background Indian Pakistani Bangladeshi Other Asian Background Chinese Mixed ethnic group Irish Traveller White Other (Please specify) We are unable to specify which group will mainly benefit 21

22 7. Marital Status The main group to benefit, will be: Married Unmarried Divorced Separated Widowed We are unable to specify which group will mainly benefit 8. Sexual Orientation The main group to benefit, will be: Gay people Lesbian people Heterosexual people Bisexual people We are unable to specify which group will mainly benefit 9. Age The main group to benefit, will be: Under 16 Aged Aged Aged Over 65 We are unable to specify which group will mainly benefit 22

23 TELL US ABOUT THE MAKE UP OF YOUR BOARD/MANAGEMENT COMMITTEE For each question mainly comprise, means more than 60% 10. Persons with a Disability The Disability Discrimination Act defines a disabled person as someone with a disability or mental impairment, which has a substantial and long-term adverse effect on his or her ability to carry out normal day to day activities Does the Board/Management committee mainly comprise: People with a Disability People without a Disability People 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: Women (including girls) Men (including boys) Transgendered people Both women and men (where neither community is over 60%) 12. Persons with Dependants We understand people with dependants to be those with personal responsibility for the care of a child, the care of a person with an incapacitating disability and/or the care of a dependant elderly person. Does the Board/Management committee mainly comprise: People with dependants People without dependants People with dependants and people without dependants (where neither community is over 60%) We are unable to specify 23

24 13. Religious Belief Does the Board/Management committee mainly comprise: Protestant Catholic Both Protestant and Catholic communities (where neither community is over 60%) Buddhist Hindu Islam / Muslim Jewish Sikh Other Religious Belief We are unable to specify 14. Political Opinion Does the Board/Management committee mainly comprise: Nationalist generally Unionist generally Other We are unable to specify 15. Racial Group Does the Board/Management committee mainly comprise: Black African Black Caribbean Other Black Background Indian Pakistani Bangladeshi Other Asian Background Chinese Mixed ethnic group Irish Traveller White Other (Please specify) We are unable to specify Please ( )one box only 24

25 16. Marital Status Does the Board/Management committee mainly comprise: Married Unmarried Divorced Separated Widowed We are unable to specify 17. Sexual Orientation Does the Board/Management committee mainly comprise: Gay people Lesbian people Heterosexual people Bisexual people We are unable to specify 18. Age Does the Board/Management committee mainly comprise: Under 16 Aged Aged Aged Over 65 We are unable to specify 25

26 SECTION 6 - ENCLOSURES Applicants based outside Northern Ireland are not required to upload documents to the Government Funders Database. If you are based outside Northern Ireland you MUST send the 5 documents listed immediately below AND all the documents listed in the tables below directly to the Arts Council at the time of submitting your application. If you are based in Northern Ireland, the following documents MUST be uploaded to the Government Funding Database at (See notes on page 2 of this application form.) 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 to supply any of the required documents along with your application will result in your application being ineligible for assessment. Please check that you have enclosed the following documents. If you fail to submit the necessary documentation or fail to provide a statement indicating why it is not applicable, your application will be ineligible. Please tick if enclosed Document 1) Copy of your Equal Opportunities Policy/Statement (signed and dated as adopted) 2) Copy of your Child Protection Policy/Statement (signed and dated as adopted) 3) A copy of a memorandum of understanding between the promoter and each of the venues for all tours (template provided on ACNI website) 4) A detailed Marketing and Audience Development Plan to support all tours. 5) Detailed description of THIS project (see Guidance Notes and page 6 of this application form) 6) Description of how your project meets the programme criteria (See Guidance Notes and page 7 of this application form) 7) Detailed income and expenditure budget for EACH 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. Itemise all expenditure where possible. If you are including ongoing overhead/administrative costs you must indicate how you have calculated the total amount e.g. total annual rent & rates ( X) amount attributed to this project ( Y). 8) Copy of the organisation s income and expenditure budget for the year in which the project will happen. 9) If the accounts uploaded to the Government Funding Database are NOT for 2014/15, then you MUST attach management accounts as at 31 March 2015 (signed and dated as adopted). 10) Details of premium payment costs, if applicable. 11) Copies of any available letters of offer from partnership funders or sponsors (if 26

27 available) 12) List of your organization s current board members, detailing what specialism they bring to their role. If applicable you should also enclose the following documents. Script/score/design details or equivalent if applying for the production of a new work CVs of proposed artists (if known Please ensure you enclose the original application form and enclosures. 27

28 SECTION 7 - PUBLICITY, OPENNESS AND ACCOUNTABILITY FEBRUARY 2016 Publicity Full 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 Data protection Data held on our grants management system is used for of the following purposes; statistical reporting, application assessing, accounting purposes and for contacting you. The details of your grant will be public information (see Openness and Accountability). However, any personal details will be held within our grants management system and our paper files, and accessed only by our staff, appointed auditors and individuals or organisations that may help us assess or monitor grants. You have a right under the Data Protection Act 1998 to access the data held on you by Arts Council of Northern Ireland. We view your signature on your application form as acceptance of the use of your data as outlined above. Please note that if you deliberately give any false or misleading information, we will withdraw your application or, if a grant has already been awarded, ask you to pay back any money we have given you. This will also have implications for any future applications you may submit. 28

29 SECTION 8 - APPLICANT S STATEMENT Please complete the section below to authorise your application. The Chair of your organisation must sign this declaration and the most senior employee or one other committee member must witness it. Please note that electronically scanned signatures are not acceptable. I confirm that I am authorised to sign this declaration on behalf of (organisation) and that, to the best of my knowledge and belief, all the information supplied on this form, and any accompanying documents, is true and accurate. I undertake immediately and fully to inform the Arts Council of Northern Ireland if any changes in circumstances require the application to be amended. I confirm that the following documents held on the Government Funding Database are the most up to date and fit for purpose for this application. o o o o o Copy of Constitution/Memorandum of Association List of office bearers Organisation Chart Copy of Audited/Certified/Adopted Accounts Rental Agreement/Lease or evidence of ownership I confirm that we remain committed to the principals outlined in Section 5; Equality of Opportunity and Good Relations Commitment Child/Young People/Adults at Risk Protection Policy Statement I confirm that the person named at Section 1 is authorised to act as the contact for the organisation in all matters relating to this application. Name (Chair): Designation: Signature: Date: Name (Senior employee or committee member) Designation: Signature: Date: The information provided on this form may be available to other departments/ agencies for the purposes of preventing or detecting fraud. If you knowingly falsify information on the application form, payments will be stopped and you will have to repay grants already received. REMEMBER TO KEEP A COPY OF THE APPLICATION FORM AND ENCLOSURES FOR REFERENCE. 29