MQA MINE COMMUNITY 2018 APPLICATIONS FORM

INSTRUCTIONS

1.Read carefully before completing, signing or submitting this form.

2.Ensure that this form is completed in full.

3.Complete in BLOCK LETTERS.

CRITERIA

4.Applications are invited from levy paying employers, municipalities, TVET Colleges and stakeholders to implement training aimed at unemployed youth and retrenched or to be retrenched mine workers.

5.Use the checklist in section B to compile the proposal and ensure that this form is duly signed

6.Please take note that applicationsarefor 2018/2019financial year andthose that are beyond this period will not be considered.

7.Application forms with incomplete and incorrect information and documentation will be disqualified.

8.No faxed / emailed application forms will be accepted.

Hand Deliver completed forms to:

The Manager

Stakeholder Relations Unit

Mining Qualifications Authority (MQA)

7 Anerley Road

Parktown

JOHANNESBURG and MQA Regional Offices

Posted to (by registered mail):

The Manager

Stakeholder Relations Unit

Mining Qualifications Authority (MQA)

PRIVATE BAG X118

MARSHALLTOWN 2107

MQA MINE COMMUNITY 2018 APPLICATION FORM

SECTION A – DETAILS OF APPLICANT

Organizational Name
Contact 1
Contact 2
Business Address – With Postal Code
Postal Code
Postal Address –
With Postal Code
Postal Code
District / Municipality / Rural (Y/N)
Province
Contact Numbers 1 / Telephone / Cellphone
Contact Numbers 2 / Telephone / Cellphone
Email Address 1
Email Address 2
Applicant Signature
Date
Office Use Only
Date Received
Name and Surname
Comments

SECTION B–PROJECT CHECKLIST

NO. / ITEM / YES / NO / REFER TO PAGE NO. FOR EVIDENCE
1 / Ensure that you company logo, name and details are on your proposal request
2 / Include the background of your project and areas of training
3 / Include your proposed budget, as per annexure B
4 / Include the time period of you training/programme/project
5 / Have you considered the correct SETA (e.g. For construction submit your request to the Construction SETA),
6 / Indicate the approximate or exact number of beneficiaries, annexure A
7 / Indicate stakeholders and/ partners responsibilities
8 / Is your project part of or in line with the local municipality Intergrated Development Plan (IDP)
9 / If working with any stakeholder, ensure you include the detail pertaining to the project
10 / If you are in partnership, enclosed you partnership agreement document or Memorandum of understanding (MOU.
11 / State milestones for the project, the timelines and when it would be concluded.
12 / Include a beneficiary breakdown as per in Annexure A
13 / Include a small write up on how the company plans to exit the project and who will the project be handed over to if need be.
14 / Make sure your proposal is only for 2018/2019 , Note that beyond this will not be considered at this point in time
15 / Give a breakdown of how you will spend the money annually , as per Annexure B
16 / Will the DTI be involved , if so provide detail
17 / Have you indicated if you are targeting youth or retrenched
18 / Is you project/ training aligned with the life of the mine, please indicate the life of the mine.

MQA/SR/04/017 Revision: 00 Approved: EMSR Date: 24/11/2017

SECTION C–ANNEXURE A

BENEFICIARY INFO:
RACE GROUP: / WHITE / BLACK / COLOURED / INDIAN / OTHER / TOTAL HDSA YOUTH / TOTAL HDSA / TOTALS:
GENDER: / MALE / FEMALE / MALE / FEMALE / MALE / FEMALE / MALE / FEMALE / MALE / FEMALE
NUMBER:
TOTALS
MALE / FEMALE / TOTALS
NUMBER OF LOCALS
OTHER
TOTALS:
NUMBER OF LEARNERS BEFINITING:
SECTION C–ANNEXURE B
BREAK DOWN OF BUDGET:
NAME OF PROGRAMME/ PROJECT:
YEAR: / 2018
BUDGET:
TOTAL:
BUDGET OVERVIEW:
PROGRAME: / DURATION: / NUMBER OF BENIFICIARIES / STIPEND PER MONTH / TOTAL STIPEND / TRAINING FEE / TOTAL
TOTAL

MQA/SR/04/017 Revision: 00 Approved: EMSR Date: 24/11/2017