Reference Number:
(For Official Use Only)
Disability Awareness Grant Scheme 2015
Promoting Positive Attitudes to People with Disabilities
Grant Application Form
Prior to completing this application form, please consult the Guidance Manual for Grant Applicants 2015. Copies are
available from www.justice.ie and www.nda.ie.
Please note: ALL relevant sections of this application form must be completed in full. The Department of Justice and
Equality and the National Disability Authority reserve the right not to consider incomplete applications.
Submitting Your Application
Closing Date:
No. of copies:
Please e-mail your application to:
Please post your application to:
Thursday, 13 August 2015 at 16:00
Please submit 3 hard copies and 1 electronic copy in MSWord
format and supporting documentation.
nda@nda.ie
Disability Awareness Grant Scheme 2015,
National Disability Authority,
25 Clyde Road,
Dublin 4.
Applicant Organisation Name
Applicant Organisation Name:
Is your Organisation a registered company and/or charity
Company Number:
Charity Number:
Part 1
1.1
Applicant Details
Is this an application from a single organisation or a joint/collaborative grant application? (Please enter ‘X’
as appropriate below)
Single organisation application [] Joint/Collaborative application [ ] Other: [ ]
If ‘Other’ please specify the nature of this application below:
1.2
1.3
Organisation(s):
In cases of joint/collaborative applications please list all partner applicants and indicate which organisation
is the lead in this project.
a) Lead organisation:
b) Partner applicant 1:
c) Partner applicant 2:
d) Partner applicant 3:
e) Partner applicant 4:
Other applicants involved (Please specify):
Full postal address of lead organisation:
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1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
Name of main contact person:
E-mail address of main contact person:
Telephone:
Fax:
Mobile:
Lead organisation’s e-mail:
Website:
Which of the below best describes the area of work of your organisation(s)?: (Please enter ‘X’ in any
appropriate box below)
a) Disability Group (service provider, support group etc):
[ ]
b) Awareness raising Group :
[]
c) Community Group: [ ]
d) Other:
[]
If ‘Other’ please specify the nature of the work of your organisation below:
1.12
Your work:
Give brief details of your organisation(s) work below:
Part 2
Project Details
(NOTE: A separate application form is required for each project for which you are applying for funding.)
Increase the size of these boxes below as required or provide information on an extra page
2.1
Please provide a brief description of the proposed project, why it is needed and what it is you hope to
achieve.
Why the project is needed:
Project Aims and Objectives:
Project Deliverables, including expected outcomes(outline the various actions involved to achieve these
outcomes):
Project Benefits:
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Project Risks:
2.2
What subject matter will this project cover? (for example , raising awareness of disability in general, or a
specific disability etc.)
2.3
Please specify the target audience for this project and the rationale for choosing same (for example,
employers, local businesses, general public.)
2.4
2.5
Please give details in support of your capacity and experience to run an initiative of the kind proposed
Geographical target area of the project (if applicable):
Please confirm that this awareness raising project is targeted at a national level? (Please enter ‘X’ in the box
below)
a) National level []
2.6
Please confirm that this is a new project (Please enter ‘X’ in the box below)
a) New project
[]
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Part 3
3.1
Project Cost
Please give the total cost of the all awareness raising activities/projects proposed relating to promoting
positive attitudes towards people with disabilities as mentioned in Part 2 of this Application:
TOTAL COST (incl. VAT) of ALL ACTIVITIES:
BREAKDOWN OF COSTS:
3.2
Please state amount of funding sought from the Department:
3.3
Please give details of any funding applied for, or received, from other sources in relation to this project:
3.4
Please give details of any discounted rates you have succeeded/hope to succeed in achieving related to
this project:
3.5
Please give details of any other ‘value for money’ or cost saving strategies employed relating to this
project:
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Part 4
Disclosure of Information under the Freedom of Information Act
The Department of Justice and Equality wishes to remind applicants that the information supplied in the application
form and supporting documentation may be released, on request, to third parties, in accordance with the
Department’s obligations under the Freedom of Information Acts 1997 and 2003.
You are asked to consider if any of the information supplied by you in your application should not be disclosed
because of sensitivity. If this is the case, you should tell us what information is sensitive and why. The Department
will consult with you about sensitive information before making a decision regarding the release of such
information.
The Department may, if requested, release information to third parties without further consultation with you,
unless you tell us that the information is sensitive.
Is any of the information provided in your application sensitive? (Please enter ‘X’ as appropriate below):
No [ Yes [ ]
If ‘yes’, what information should be treated as sensitive and why?
If you consider that none of the information supplied by you is sensitive, please complete the following
statement:
(Name of lead organisation):
hereby agrees that none of the information supplied is sensitive, and
acknowledges that any, or all, of the information supplied may be released in response to a Freedom of
Information request.
Signed:______________________
Name (in block capitals please):
Date:
Part 5
Disclaimer
It will be a condition of any application for funding that the applicant has read, understood and accepted the
following:
1. The Department of Justice and Equality shall not be liable to the applicant or any other party in respect of any
loss, damage or costs of any nature arising directly or indirectly from:
a) The application or the subject matter of the application
b) The rejection for any reason of the application
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2. The Department of Justice and Equality shall not at any time in any circumstance be held responsible or liable
in relation to any matter whatsoever arising in connection with the development, planning, operation,
management and/or administration of individual projects
(Name of lead organisation:
has read, understood and accepted the disclaimer above
Signed:__ ___________________________________________________________
Name (in block capitals please):
Date:_ __________________
Part 6
Requirements of the Scheme
Please confirm that you have read and understood the requirements of the scheme as set out in the Guidance
Manual for Grant Applicants 2015, and that your organisation meets these requirements:
Signed:_____ ________________________________________________________
Name (in block capitals please):
Date:__ ___________________________________
Part 7
Checklist:
Prior to returning this form, please check you have:
(Please enter ‘X’ as appropriate below):
1. read and understood the terms of the scheme as set out in the Department of Justice and Equality
Guidance Manual for Grant Applicants 2015
No [ ] Yes []
2. completed all relevant sections of this Application Form
No [ ]
Yes []
No [ ]
Yes [ ]
3. signed the declarations at Parts 4, 5 and 6 regarding Freedom of
Information, Disclaimer and the requirements of the scheme
4. provided 1 electronic copy in MSWord format and 3 hard copies of the application form and any
supporting materials
No [ ] Yes [ ]
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