Rural Development Programme LEADER Expression of Interest (EOI) Form

Transcription

1 Rural Development Programme LEADER Expression of Interest (EOI) Form Theme 1: Economic Development, Enterprise Development & Job Creation (Call Opens on Monday 13 th Nov 2017 / Closes at 5pm Friday 24 th Nov 2017) NOTE: In order for projects to be considered for funding under these categories, Applicants must complete a two stage application process: Stage 1: Complete this Expression of Interest form to determine if your proposal meets the objectives of the County Waterford Local Development Strategy and complies with the LEADER Programme guidelines. Stage 2: Applicants that are successful at Stage 1 will be invited to submit a full application with the required supporting documentation. Invitation to application stage does not mean that you will be awarded grant aid as it is a competitive process. Completion Guidance Notes: Please complete this form in full. All fields are mandatory. This form can be downloaded or printed from and posted to Waterford Leader Partnership CLG, Lismore Business Park, Lismore, Co. Waterford. A hardcopy of this form can be obtained from Waterford Leader Partnership on A Rural Development Officer from the Waterford Leader Partnership will contact you when your Expression of Interest Form has been reviewed. For further information, please visit: Projects in East Waterford Projects in Mid & West Waterford Ms Claire Connors Mr Jimmy Taaffe claire.connors@wlp. jimmy.taaffe@wlp.ie 1

2 Rural Development Programme (Leader) Expression of Interest (EOI) Form GENERAL INFORMATION All Fields are mandatory and must be completed. Your Local Action Group (LAG) name: Waterford Leader Partnership CLG, Lismore Business Park, Lismore, Co Waterford. Tel: E: W: Project Name / Title: Promoter s / Community Group s Name: Promoters Lead / Main Contact Name: Promoters Main Telephone No.: Promoters Address: Promoter s Address: Classification of Promoter: Cross appropriate box and include copies of supporting governing documents with this application. Promoter Type: [Individual, Community Group, Organisation, Other]. Sole Trader Community Council Farmer(If Yes Herd No. is required below) Trust Formalised Community/Voluntary group Partnership Companies Limited by Guarantee Limited Company Designated Activity Company limited Public Body by shares Registered Charity Private Individual Cooperative society registered under the Industrial & Provident Societies Act Herd Number: 2

3 Has Promoter / Community Group received Leader funding previously? Please tick one YES NO PROJECT INFORMATION Project Address : Project located in Gaeltacht area : Project located on Islands area : Estimated Project Costs: [Total estimated costs] Leader Funding Required for project: YES NO YES NO Projects Other Funding sources (If Any - Bank Loans etc.) Sub Theme: (Tick one sub theme only) Rural Development Theme 1: Economic Development, Enterprise Development & Job Creation Rural Tourism Enterprise Development Rural Towns Broadband Please give a brief description of the proposed project. [Please use additional sheet and attach to this form if required.] 3

4 Signed for and on behalf of the Promoter / Group: I/ We confirm that the details supplied are true and correct to the best of my/our knowledge Print Name: Signature: Name in Block Capitals: Date: / / Part or all of the information you provide will be held on computer and hard copy format. This information will be used for the administration of Expression of Interests and producing monitoring returns. LAG s may share information with each other and government departments/agencies to enable them to prevent fraudulent applications or for detecting crime and to co-ordinate processing of complementary applications. It may also be subject to meeting obligations under the Freedom of Information Act as amended. This policy does not affect your rights and your information will be held as prescribed under the Data Protection Acts 1988 and Please complete, sign and date both the EOI form and the Form of Consent and return to Waterford Leader Partnership CLG, Lismore Business Park, Lismore, Co Waterford by the required date. copies will not be accepted. 4

5 FORM OF CONSENT Computerised Records Waterford Local Community Development Committee (LCDC) is responsible for delivering the Rural Development Programme LEADER with Waterford Leader Partnership CLG (WLP) as implementing partner and Waterford City & County Council (WC&CC) as financial partner. We are required to collect information on individuals and community groups who we assist. As soon as you contact Waterford Leader Partnership and its partners, a record is created in your name for the information you provide. The information will be stored by Waterford Local Community Development Committee and its implementing partners where relevant in paper/electronic form. Information that we then collect including information that you give us is added to the record. You have the right, given by the Data Protection Act of 1988 and 2003 to a copy of your information at any time. A fee of 6.35 is payable for each request. Requests should be addressed to: Waterford Leader Partnership CLG, Lismore Business Park, Lismore, Co Waterford. The information we record is used only for the following purposes: Processing applications Auditing applications (Article 48 check) Compiling statistical information to assist us in planning and improving our services and producing our own statistics for publication Analysing information about applicants for other bodies such as Government Departments Publication of applicant and project details (including photography) for publicity and promotional purposes. Personal information about you will be disclosed only in accordance with Waterford Leader Partnership CLG registration under the Data Protection Act. Example of disclosure: Waterford Leader Partnership is required to give promoter s names and certain other personal data to the Rural Development Division of the Department of Agriculture, Food and Rural Development, Waterford Local and Community Development Committee, Waterford City & County Council, Pobal, the Department of Rural & Community Development, the Evaluation Committee and the EU Commission and their Auditors. These in turn observe strict rules of disclosure that are registered with the Office of the Data Protection Commissioner. 5

6 Non-Computerised Records Other information supplied and collected may also be disclosed to people and bodies from time to time. On request you can receive a list of disclosures. 1.1 DECLARATION I have read and understand the above statement and give consent to Waterford Leader Partnership for the use and disclosure of data and information as outlined above. Name: Date: For Office Use Only EOI Ref ID: (Generated from RDP IT System) Call Type: (Rolling / Time Limited). Main Programme Theme: WLP Project Officer Signature: Printed name of WLP Project Officer: Date form Received from Applicant in WLP: / / WLP Date Stamp: 6