Request for MSF Support for

Change of Use for premises

Instructions:

1)Please complete all sections of this application form and submit it together with supporting documents to:

Email:, or

Address:Premises Support Request Application

Facilities Branch

Service Support & Resource Division

Ministry of Social and Family Development

510 Thomson Road #16-02

Singapore 298135

2)Incomplete or illegible applications will not be considered.

3)IMPORTANT NOTE:

•MSF supports direct grant of tenancy of State Property / HDB void deck for VWOs to operate direct social services[1]. For all other services not under MSF’s purview, please approach the relevant supervisory authority / Ministry to request for support.

•The prerequisite of this application is VWOs should have either Charity or IPC status. The social services provided must not have any racial, religious or sectarian connotation.

•Stay-in/residential facilities, facilities for headquarters or office administrative purposes are not eligible for HDB void deck premises.

•MSF’s support is subject to regular reviews every 3 years on continued relevance of the proposed social services and programmes.

•MSF’s support for direct grant of tenancy does not extend to (a) capital funding for renovations, upgrading, maintenance etc. of the allocated premises; and (b) rental subvention or funding for other tenancy related costs such as security deposit, fire insurance policy, processing fee or stamp duty, etc. in part or whole.

Section A: Particulars ofVoluntary Welfare Organisation
Name of organisation:
Current address:
Website Address:
Email:
Telephone/ Fax:
Section B: Contact information of the Person In Charge of Application
Full name:
Title/Designation:
Email:
Contact number (mobile/ office/ fax):
Section C: Legal Status of Voluntary Welfare Organisation
Please check () the relevant box (if applicable)
Registered under Registry of Societies/ Accounting and Corporate Regulatory Authority/ Established under Written Law.
Registration number: ______
Registered with Commissioner of Charities as charity
Charity registration number: ______
Acquired Institution of Public Character (IPC) Status
IPC registration number: ______
Note: Please provide photocopy of all the relevant registration.
Section D: Request for change in use for premises
Address of the site with the change of use :______
Please give a brief description on the reasons for the change of use.

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Section E: Details of new programmes
Description of the new programme(s)
Please provide detailed information on the following:
  1. Provide information on the types of programmes, clientele, frequency and outcomes of the new services/programmes to be operated in the premises.
Name of programme / Description /
Target Clientele and needs
/
Age
/
No. of clients served per year
/
Regularity
/
Desired outcomes
Eg. Befriending, counselling / Programme to engage youths and to be a friend by lending a listening ear. / Youths who are exhibiting signs of being at-risk , Seniors, people with special needs / 50-60 yr old / 50 people / Daily, Weekly, Monthly / Reduced number of school drop outs
2. Please indicate the areas that the programmes will serveEg: Bishan, entire nation, NorthEast Community Development Council boundary
  1. Any future plans for collaborations and referral partnerships with any other organisation?Eg. Referral by schools, MSF, collaborations with other VWOs

  1. Sources of funding for the proposed programmes/services.

  1. Please highlight similar social services or programmes serving the same profile of clients in the vicinity of the requested premises (e.g., 2km of the proposed location).
Note:Please attach more details, such as localised demographic data, studies and/or surveys done(if available).
Section F: Support from grassroots and any other organisations
Please provide comments from the grassroots (e.g., CCCs, RCs) on whether the proposed services meet the local community needs. Please also attach any support from the grassroots and other organisations.
Note: Please attach a copy of the comments and/or documentation of support (if available).
Section G: Details of premises
Please provide the following information on the proposed space usage:
  • Proposed space breakdown and utilisation (in the table below)
  • Layout plan or rough sketch showing floor area usage (if available)
Type of room(s) required / Floor area (m2) of room(s) /
Purpose
(for programme, activity, admin, etc)
/
Frequency of use
/
Capacity per room
[For example:]
Counselling room / 2m2 X 2 /
For counselling of clients
/
3 times / week
/ 4 pax per room
Admin office / 5m2 /
For office admin
/
Daily
/ 8 pax per room
Toilet, Pantry / 1m2 /
Basic office amenities
/
Daily
/ N.A.
TOTAL / About ___ m2
Section H: Declarations
We declare that:
i)our organisation is free from any litigation;
ii)all the facts stated in this application and the accompanying information are true and correct to the best of our knowledge and that we have not withheld/ distorted any material facts. We understand that if we obtain MSF support by false/ misleading statements/partial disclosure not in line with the support intent, MSF reserves the right to immediately withdraw the support; and
iii)weunderstand that MSF reserves the right to reject our application, and that the reason(s) for which the application is rejected need not be disclosed.
SIGNATURE OF CHIEF EXECUTIVE OFFICER/ EXECUTIVE DIRECTOR/ BOARD CHAIRMAN / SIGNATURE OF CENTRE/ PROGRAMME MANAGER / ORGANISATION STAMP
NAME (IN BLOCK LETTERS) / NAME (IN BLOCK LETTERS) / DATE

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[1]The VWOshould be providing direct social services, which contribute to the psychological and social well-being of target clients. This excludes health, direct financial aid, legal, sports, recreation and education programmes.