NATIONAL ARTS COUNCIL OF SOUTH AFRICA APPLICATION FORM FOR ARTS ORGANISATION SUPPORT FUNDING It is compulsory to complete all relevant sections of this application form ARTS ORGANISATION SUPPORT FUNDING Invitation to arts organisations and companies to submit funding proposals for the Arts Organisation Support Funding for 2016-2018 funding cycle. Please indicate the status of your organisation in terms of three (3) categories below: Foundation phase: Intermediary phase: Established phase: Please refer to the Funding Criteria and Guidelines for further details on funding categories. SUBMIT APPLICATIONS TO THE NATIONAL ARTS COUNCIL BY POST OR COURIER: Direct all queries and requests for additional application forms to the NAC: Telephone: (011) 8381383 Email: thato@nac.org.za This form is also available in PDF at www.nac.org.za Postal Address: PO Box 500 Newtown Johannesburg 2113 Physical Address: 66 Margaret Mcingana Street Newtown Johannesburg CLOSING DATE: 22 JANUARY 2016
GUIDELINES: (read these guidelines carefully before completing the application) Provide honest and accurate information. If you misrepresent information, your application will be disqualified. It is compulsory to complete all relevant sections of the application form. If you do not provide all the information required, your application will be considered incomplete. Where information is not applicable to your organisation, state that it is not applicable by writing N/A in the appropriate place on the form. Ensure that all the required supporting documents are included in your application as per the funding guidelines. Below is a checklist of compulsory documents to be attached: Required Documentation Note that this documentation is mandatory Completed application form. The profiles and/or detailed CV s of the individuals empowered to sign the contract and other members of management in the organisation. Certified copies of the identity documents of the individuals empowered to sign the contract and other members of management in the organisation (not older than three months). Original and valid tax clearance certificate. A three year business plan. Annual audited financial statements or financial report prepared and signed off by a registered accountant (please refer to funding criteria). A certified company registration certificate (recently certified i.e. not older than 3 months). Samples of work done/media reviews. Three reference letters from a provincial structure such as a Provincial Arts and Culture Council (PACC), Municipality, Community Leader, etc. (not older than 6 months). 2 P a g e
SECTION 1 APPLICATION DETAILS A: Art Form Which of the following art form (s) is relevant to your field? Craft Dance Literature Multi-disciplinary Music Theatre/ Drama Visual Arts Other (Specify): B: Type of Organisations PTY (Ltd): CC: Cooperative: Other (Specify) Trust: Non-Profit Company (NPO) Other: C: Preferred method of Communication Email: SMS: Fax: D: How did you hear about the call for Applications? Please choose an option: Advertisement: Sunday Times: Daily Sun: Sowetan: Volksblad: NAC Website: Email: Artslink: Facebook / Twitter: Other (Specify): 3 P a g e
SECTION 2 ORGANISATION / COMPANY DETAILS Organisation / Company Name How long has organisation been in existence? Registration Number: Tax number: Title: Coordinator s Full Name: Surname: ID no: Cell: Tel: Fax: Email: Physical address: Province: Web address: Postal address: Code: Locality: Rural: Urban: Name of Municipality/Metro: Total funding requested from NAC (for a period of 3 years): R SECTION 3 ORGANISATION / COMPANY PROFILE How many staff members does your organisation employ? EMPLOYMENT STATUS MANAGEMENT ADMINISTRATION CREATIVE FULL TIME PART TIME CONTRACT VOLUNTEERS TOTAL 4 P a g e
SECTION 3 CONTINUED ORGANISATION / COMPANY PROFILE What is your annual operating budget: Which of the following will the funding impact on? Who are the main beneficiaries of your organisation? etc. List key management positions within your organisation: Name and Surname: Position: Name and Surname: Position: Name and Surname: Position: List all sources of income: 1. Government/Public Funding Amounts: Name: R Name: R 2. Sponsorships/Private Funding Amounts: 3. Other Income: Amounts: Source: R Source: R Source: R 5 P a g e
SECTION 4 CONTINUED ORGANISATION / COMPANY PROFILE List major highlights or achievements of your organisation in the last three (3) years: Local Achievements: International Achievements: Do you own or rent your operating facility: Yes years No Specify the number of Other Facilities: DECLARATION I confirm that I have the authority to complete and sign this application on behalf of the organisation named in this application. I further confirm that the activity for which the organisation is applying for falls within the mission and constitution or memorandum and articles of association of the organisation. All the information provided in the application is true and accurate to the best of my knowledge. I understand that any misrepresentation of such information is a serious offence that will lead to the disqualification of this application and may result in prosecution. Name and Surname of the person who is authorised to sign the form Designation in the organisation: Signed at on 2016 Full name/s of co-signatory office bearer in a management position: Designation in the organisation: Signed at on 2016 6 P a g e