Equipmentand Minor Refurbishment Programme

July 2013

Equipmentand Minor Refurbishment Programme

Confirmation of Online Application

This completed form and relevant enclosures (as detailed in section 5) must be received by the Arts Council within five working days of your application being submitted.

Thank you for completing sections 1 to 4 of your application online.

In order to process your application, we are required to obtain the following signed statements in hard copy. Please also complete section 2.10 attached if you chose not to complete this online.

This confirmation of online application and accompanying documents must be received within five days of your application being submitted. Please note: Proof of postage is not proof of delivery.

Please send your confirmation to:

Arts Council of Northern Ireland

MacNeice House

77 Malone Road

BELFAST

BT9 6AQ

SECTION 2.10 – BANK DETAILS

Name of Bank/Building Society ______

Address ______

Town______Postcode ______

Account Name ______

Account Number ______

Sort Code

- / -

SECTION FIVE - ENCLOSURES

You must enclose the following documents. Failure to enclose any of the listed documents, or failure to provide a statement indicating why it is not applicable will mean your application will be regarded as ineligible and will be immediately returned to you.

Applicants in receipt of AFP funding in 2013/14, who submitted the documents listed below for the Arts Council Masterfile and have not amended the documents since they were submitted, do not have to provide the following documents:

1)Constitution and/or Memorandum and Articles of Association

2)Organisation’s Child Protection Policy (if applicable)

3)Organisation’s Equal Opportunities Policy

Office

Tick Use

Copy of Constitution and/or Memorandum and Articles of Association
NOTE: This must be the same as the name on your bank account and on your accounts. (signed and dated as adopted)
Copy of Equal Opportunities Policy (signed and dated as adopted). This policy must be a separate document. It is not a clause in your constitution and it is not the equality statement within this applicationform.
Copy of Child Protection Policy (if applicable; signed and dated as adopted). This policy must be a separate document. It is not a clause in your constitution and it is not the Child Protection Policy statement within this applicationform. Policies older than 3 years will not be accepted.
Completed Safeguarding Checklist. Due to changes in Government legislation, all organisations dealing directly with children, young people and vulnerable adults MUST complete and return the Safeguarding Checklist. This document is additional to your organisation’s child protection policy.
Copy of last year’s certified or audited accounts: These must be in the format set out in your Constitution and must be signed and dated by an independent person (i.e. not the organisation’s Treasurer). These should be to a date at most 9 months prior to the date of your application. If this is not available please provide the most recent certified or audited accounts (signed and dated as adopted) and in additionthe most recent set of management accounts (signed and dated as adopted), which should bewithin the specified period.
Description of how your project meets the programme criteria as listed in the Guidance Notes for this programme. Identify and address each criterion in no fewer than 200 and no more than 500 words. You must address and number each criterion separately.
Itemised, costed list of all equipment/refurbishment work required including description of potential usage.
Copy of the organisation’s income and expenditure budget for the year in which the project will happen.
Please ensure you send in the application form with an original signature and keep a copy of the form and enclosures for yourself.

SECTION SIX – EQUALITY OF OPPORTUNITY AND GOOD RELATIONS COMMITMENT, CHILD PROTECTION STATEMENT, SAFEGUARDING CHECKLIST AND BENEFICIARIES

6.1. GOOD RELATIONS POLICY

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.

Applicants should note that, in carrying out its functions, the Arts Council will check the content of newspapers, websites, including social networking sites, and other documents to establish that the applicant is acting within the ethos of good relations. Where evidence is found that an applicant is not acting in the interests of good relations, applications will be considered ineligible or, if evidence is found after an award is made, funding will be withdrawn

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 …………………………………………………………………

6.2.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”

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: / Please () one box only
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

Men and Women

The main group to benefit, will be: / Please () one box only
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

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: / Please () one box only
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

Religious Belief

The main group to benefit, will be: / Please () one box only
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

Political Opinion

The main group to benefit, will be: / Please () one box only
Nationalist generally
Unionist generally
Other
We are unable to specify which group will mainly benefit

Racial Group

The main group to benefit, will be: / Please () one box only
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

7.Marital Status

The main group to benefit, will be: / Please () one box only
Married
Unmarried
Divorced
Separated
Widowed
We are unable to specify which group will mainly benefit

Sexual Orientation

The main group to benefit, will be: / Please () one box only
Gay people
Lesbian people
Heterosexual people
Bisexual people
We are unable to specify which group will mainly benefit

The main group to benefit, will be: / Please () one box only
Under 16
Aged 16 – 25
Aged 26 – 50
Aged 50 – 65
Over 65
We are unable to specify which group will mainly benefit

TELL US ABOUT THE MAKE UP OF YOUR BOARD/MANAGEMENT COMMITTEE

For each question “mainly comprise”, means more than 60%

Persons with a Disability

Does the Board/Management committee mainly comprise: / Please () one box only
People with a Disability
People without a Disability
People with a Disability and People without a Disability
(where neither community is over 60%)

Men and Women

Does the Board/Management committee mainly comprise: / Please () one box only
Women (including girls)
Men (including boys)
Transgendered people
Both women and men
(where neither community is over 60%)

Persons with Dependants

Does the Board/Management committee mainly comprise: / Please () one box only
People with dependants
People without dependants
People with dependants and people without dependants
(where neither community is over 60%)
We are unable to specify

Religious Belief

Does the Board/Management committee mainly comprise: / Please () one box only
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

Political Opinion

Does the Board/Management committee mainly comprise: / Please () one box only
Nationalist generally
Unionist generally
Other
We are unable to specify

Racial Group

Does the Board/Management committee mainly comprise: / Please ()one box only
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

Marital Status

Does the Board/Management committee mainly comprise: / Please () one box only
Married
Unmarried
Divorced
Separated
Widowed
We are unable to specify

Sexual Orientation

Does the Board/Management committee mainly comprise: / Please () one box only
Gay people
Lesbian people
Heterosexual people
Bisexual people
We are unable to specify

Does the Board/Management committee mainly comprise: / Please () one box only
Under 16
Aged 16 – 25
Aged 26 – 50
Aged 50 – 65
Over 65
We are unable to specify

6.3 CHILD PROTECTION POLICY STATEMENT

Due to changes in Government legislation, it is a requirement of our funding that all organisations which come into contact with children, young people and vulnerable adults, either directly through its programmes or indirectly through its services, mustcommit to a Child Protection /Safeguarding Policy. 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 the Safeguarding Checklist 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 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.

In addition to signing this statement, you are also required to submit a copy of your Child Protection/Safeguarding Policy and Procedures (see Enclosures section) Please note Policy and Procedures which are older than 3 years will not be accepted. If your 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.

We (name of organisation) ……………………………………………………………….

are committed to practice which protects children from harm. Staff, volunteers and artists in this organisation accept and recognise their responsibilities under the Children (NI) Order 1995, about safeguarding children, and will endeavour to carry these out by:

having an awareness of the issues which cause children harm;
adopting child protection guidelines for staff, leaders, volunteers and artists;
providing information about child protection and good practice to children, parents, staff, volunteers and artists;
sharing information about concerns with children, parents and others 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 child protection policies under regular review; and
providing information as required to management committees/ funders

This Child Protection Policy statement was formally adopted by us on

(insert date) ………………………………………………………………………………...

Authorised Signature ………………………………………………… Date ……………

Position in Organisation ……………………………………………………………………

Safeguarding Checklist

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
Promoted on web site
Does your organisation have written procedures for recruitment and selection of staff and volunteers? / Written job description
Written application form to include request for references and self declaration.
Record of interview
Follow-up on written references
Is your organisation registered with Access NI . / Date of certificate and name of registered person/s (Please provide information in comments)
Is your organisation registered with an umbrella body to obtain Access NI checks . / Name of the umbrella body that conducts Access NI checks on your behalf(Please provide name of body in comments)
Are all staff and volunteer appointments subject to the appropriate safeguarding checks and these are properly recorded. / Access NI reference check recorded
Written list of roles that are “regulated” within the organisation
Proof of ID request
Does your organisation provide Safeguarding training for Designated Officer, staff and volunteers? / 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)
Does your organisation regularly re-evaluate and update your safeguarding training and education? / Copy of letters/memos/certificate outlining Safeguarding training provided to staff.
Does your organisation have written procedures for reporting child protection concerns, disclosures and allegations? / Written procedures for reporting concerns to Designated Officer and statutory services
Pro formas/written guidance.
Are the procedures for reporting concerns communicated to staff and volunteers? / Confirmation from staff (especially recently recruited) that they have received safeguarding training and written reporting procedures
Does your organisation have an open complaints process that includes guidelines on a disciplinary process? / Copy of complaints, disciplinary and appeals process.
Evidence of how this is communicated to stakeholders
Does your organisation have written procedures for Designated Officers? / Written documents stating the name and up to date contact details of Designated Officers.(Please name Designated Safeguarding Officer(s)in comments)
Are the contact details of Designated Officers communicated to staff/volunteers? / Written evidence to support that staff, members and volunteers are aware of who to contact and how.
Confirmation from staff/volunteers
Do you have a written Code of Behaviour? / Written Code of Behaviour
Evidence this is communicated to all stakeholders
Do you have a written Safeguarding policy and procedures, endorsed and approved by Management Board? / Written Policy Statement and associated procedures
Please advise when last reviewed and updated.
Do you communicate your Safeguarding policy statement to staff/volunteers/children/
young people/ vulnerable adults and parents? / Confirmation from staff/ volunteers/ children/ vulnerable adults and parents that they received a copy or know where to access the policy

SAFEGUARDING CHECKLIST COMPLETED BY:

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 web site, 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

SECTION SEVEN - PUBLICITY, OPENNESS AND ACCOUNTABILITY

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 2000any information held by us (which will include your application) is potentially accessible by the public.