DISCRETIONARY GRANT: PUBLIC SECTOR APPLICATION

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DISCRETIONARY GRANT: PUBLIC SECTOR APPLICATION (This form is for a public sector/government entity applying for a grant where they themselves are accredited to provide the training or if they are applying with another preferred provider) Project Name (As per the advert) Closing Date for Submission Specify who you are applying on behalf of (Please tick) Please indicate what type of project you are applying for (Please tick) Employer Provider Both Employed Bursaries Unemployed Learnerships Employed Learnerships Unemployed Skills Programmes Employed Skills Programmes Internships TVET Placements University Graduate Placements Artisans AET NB! Preferred Providers must attach all relevant documents as per the requirements of the advert. Applying with an employer that prefers you as a training provider does not guarantee you an automatic recommendation. All applicants will be evaluated as per SASSETA policies.

Guidelines: Applying for DG funding by private providers Any Department falling under the primary scope of SASSETA and making financial contributions to SASSETA may apply The Department must have submitted their Workplace Skills Plan and or Pivotal Training Plan Each application should respond to the advertisement. Ensure that you are familiar with the NSDS III document of the Department of Higher Education; the SASSETA Sector Skills Plan and SASSETA Discretionary Grants Policy. Completing the DG Application It is compulsory that all applicants complete ONE application form per project applied for. It is also compulsory that the following documents are included in Each application. The certified stamp on the copies must not be older than THREE months: 1. Skills Development Levy Number/Proof of registration for levies under SETA 19/Proof of Exemption 2. Proof of accreditation and Programme approval from the relevant SETA or Quality Assuring Body for the specific learning programme being applied for. Also provide Assessors and moderators registration documents. 3. Original Valid Tax Clearance Certificate/Certificate of good standing issued by SARS/ Tax compliance status with one time pin number ( Where applicable) 4. A detailed budget clearly stipulating the breakdown cost of training per line item to be completed on the application form Ensure that each relevant field in the application is completed. Each application to be signed off by the employer and a labour /staff representative. 2 P a g e

All submissions must either: - be hand delivered to the mailroom at the SASSETA Office: Riverview Office Park, Janadel Avenue (off Bekker Road) Midrand; or - Posted to SASSETA at PO Box 7612 Halfway House 1685. Please indicate on the outside of the envelope, as indicated in the DG Advert, the following: - Funding Window - Project Applied for DepartmentName: Skills Development Levy (SDL) Number: (Where applicable) Are you an Employer Do you Contribute levies (If Yes please specify which SETA do you contribute to ) Yes No Yes No 3 P a g e

PART A: ADMINISTRATIVE DETAILS A1 Details of the Applicant (The Department/Public Entity) Department: Postal Address: Postal Code: Size of the Organization/Company: 0-49 50 149 150+ Mark with an X Contact Person Name Telephone Email Cell Details of the Mandated Representative Name Telephone Email Cell 4 P a g e

A1 Details of the Applicant (The Department/Public Entity) Details of the relevant project management team 1. Name Email Telephone Cell 2. Name Telephone Email Cell 3. Name Telephone Email Cell Banking Details Account Holder: Bank: Account Number: Branch Code: 5 P a g e

Preferred Providers/providers partnering with *Attach all supporting documents for the preferred provider e.g. Tax clearance, Company registration and Accreditation etc. Preferred Provider Name: Accreditation Number: Quality Assuring Body: Programme Approval Details: Tele No: Cell: Fax No: E-mail: Reasons for the choice of preferred provider by the employer Capacity to deliver Qualified and experienced Project Team Qualified and experienced facilitators Qualified and experienced assessors and moderators Costing Within the budget Reasonable Cost Per Learner First time applicant Project plan Vulnerable Group Had not previously been awarded a SASSETA Discretionary Grant training project? Well-structured Project / Implementation plan Company owned by Youth, Women and People with Disabilities 6 P a g e

No Discretionary Grants Project as advertised Type of Project as specified on the cover page NQF level No of learners 18.1 18.2 (Employed) (Unemployed) Total Amount Requested Breakdown of line item Budget: Item Costing Total Cost: 7 P a g e

Company Details of the Accredited Training Provider (if Applicable) Full Name of Provider Trading as BEE Yes No Company Owned exclusively by Management includes Company Contact Details Youth Women People With Disability Youth Women People With Disability Physical Address (including Postal Code) Postal Address (including Postal Code) Company Registration No. Phone E-mail Levy No Fax Company Tax No Location of company Rural Urban Province Contact Person Name & Surname Phone Cell E-mail 8 P a g e

Please complete the following tables to indicate the equity spread of the learners across provinces ***NB: It should be noted that as per the transformation imperatives of the NSDS III the learner split should be as follows: atleast 80% Black, atleast 20% other, Women 54%, Men 46% and atleast 5% of learners with disabilities. Provincial Equity Distribution WC Gauteng NWP Limpopo KZN Mpumalanga FS EC NC Black Coloured Indian White Disability M F M F M F M F M F -35 + 35-35 + 35-35 + 35-35 + 35-35 + 35-35 + 35-35 + 35-35 + 35 9 P a g e

APPLICANT S DECLARATION I/We the undersigned hereby declare and certify that: The information provided in this application is factually correct in all material respects That we don t have a relative or kinship with persons employed by SASSETA including a blood relationship That we do not have any unlawful past supply change management practises That there is no "Collusive under any grounds II/We are duly authorized to submit this application on behalf of (name of applying Department/organization) Department Representative/Organization Full Name: Designation: Signature: Date: Employee (Labour) Representative: (Where applicable) Full Name: Position in Union: Signature: Date: 10 P a g e

N.O Check List Applicant to tick : SASSETA Official to tick : Yes N/A No Yes N/A No 1. We requested assistance from SASSETA where clarity was needed 2. The Discretionary Grant Guidelines were considered in completing this application. 3. Each relevant and required section of the application form has been duly completed. 4. Each supporting document is in line with the application requirements 5. The accreditation details requirements are in order. 6. The capacity requirements (assessors / moderator) requirements are in order and attached. 7. Each of the legal compliance (Tax clearance / CIPRO/PSIRA/ COID) requirements is in order.(attached) 8. The certified documents are not older than three months. 9. The application is an original (not a copy of a copy) 10. Each relevant organisational party endorsed this application? 11. The applicable and authorised company representative signed-off the application form. 12. The application is a product of consultation with the relevant stakeholder parties? 13. The application is signed and dated (where appropriate) by each relevant party 14. The coversheet template is pasted on the back of the envelope. 15. This application is accompanied by a duly completed provider application form. 16. An independent person checked this application for compliance with each requirement. 17. The application is posted / hand delivered to reach SASSETA by the due date and time. 18. A separate application must be completed for each project being applied for 11 P a g e