Please Ensure You Answer All Questions in Both Sections a and B

Please ensure you answer all questions in both Sections A and B.

Please ensure that your Application is signed off by both Co-Ordinator and Chairperson at Section B.

You may provide any additional relevant information that may support your application at Section C. Please note full amount of funding sought cannot be guaranteed.

Section A

Project: ______

Amount Sought ______

File Reference: ______

Section B

Unit Responsible – TUSLA Commissioning Unit

Grant Proposal

Section C

Additional Comments/ Information that may support your Application

Name of Organisation : ______Ref No : ______

SECTION A

File Reference
(for Official use Only)
Tax Clearance Cert. No
Tax Access No
Co-Ordinator’s Name
Name of Organisation
Address
Telephone No
Mobile No
Contact person in FRC
In relation to application
Email address
Details of the Project
Year established
Type of Project
County
Region

SECTION B

GRANT PROPOSAL

Purpose of Application
Total Amount of Funding sought / €
Please provide detailed breakdown of funding sought, include a Breakdown of Quotes/Estimates under EUR5,000 one Quote, over EUR5,000 three Quotes
Please Note The National Procurement Policy applies
Please give Rational for Funding sought
If Small Works are being carried out, please confirm if the Contractor is Tax Compliant / YES [ ] NO [ ]
Estimate Date of Commencement of Work/Purchase of Goods
Have you recently applied for Funding from another Statutory/Voluntary Organisation for the proposed Works/purchase of Goods / YES [ ] NO [ ]
If yes, please provide details
Date of Application
Outcome
Pending / ______
______
YES [ ] NO [ ]
Has this Application been agreed and signed off by the Board and Co-Ordinator of the FRC / YES [ ] NO [ ]
Signatures / We hereby give an undertaking to commit to spending Tusla, FRC Programme Once- Off Exceptional Small Funding, if awarded, for the purpose for which it was given and make available Receipts of Purchases, when requested. We will adhere to the National Procurement Policy
Signature Chairperson :______Date ______
Signature Co-Ordinator : ______Date ______

SECTION C