Application form for funding under the Asylum, Migration and ... · Web viewApplication form for funding under the Asylum, Migration and Integration Fund 2014-2020 Keywords Asylum,

Application form for funding under the Asylum, Migration and Integration Fund 2014-2020

ISDAF 1

Application Form - Part 1

ISDAF 1


Call for Applications - Regional Support Organisations

ISDAF1

Application Form Part I

This document is Part I of a two-part Application Form. You must also complete and submit Part II of the Application Form, which is an excel spreadsheet showing your Project Budget.

In responding to the questions posed in this application form you should refer to the Information and Guidance for Applicants which provides instructions on what is being sought in each response.

Applicant Organisation

Name of Project

Official use Only

Date application received:

Unique Project Reference ID

Section 1: Capacity of Applicant

1.1 Details of Applicant Organisation

1.1.1 Enter the legal name and main contact details of the organisation applying for funding.

(a) Organisation Legal Name

(b) Other Name(s) by which the organisation is known (i.e. Trading Name)

(c) Address

(d) Main Telephone Number

(e) Main Email Address

1.1.2 Enter some additional information on the organisation applying for funding

(a) Date of establishment of organisation

(b) Number of staff currently employed in organisation (Whole Time Equivalents)

(c) Organisation Category

Which of the following best describes your organisation

|_|

(i) Public Body

|_|

(ii) Private Company

|_|

(iii) Voluntary Organisation

(d) Organisation Legal Form

Please tick one box only )

|_|

Statutory Body

|_|

Company

Please specify type:

Enter CRO Number:

|_|

Other (please specify):

(e) Are your accounts audited annually

|_| Yes

|_| No

(f) Accounting Year End (DD/MM)

1.1.3 Enter the contact details of the main person who will be responsible for answering any queries concerning this application.

Name

Title/Position in the Organisation

Address

(if different to that provided in 1.1 above)

Telephone Number (landline)

Telephone Number (mobile)

Email Address

1.1.4 Enter the details of your organisation’s Tax Clearance Certificate (TCC)?

Tax clearance in place

|_|Yes

|_| No

|_|Application underway

Tax Reference ID

Tax Clearance Access Number

1.2 Corporate Management and Governance

1.

2.

1.2.1 Describe the management and governance structure of your organisation. Please attach an organisation chart. Suggested limit 100 Words

1.2.2 Describe the operational management and control systems that will be established for this project. Suggested limit 150 Words

1.3 Financial Management

3.

1.3.1 Outline what controls your organisation has in place to ensure good financial management. Suggested limit is 150 Words

1.3.2 Since 1 January 2017, has your organisation received grant funding from any source (including EU funds)?

|_|YesIf yes, supply brief details of these in the following table.

|_|NoIf no, move directly to next question

Year

Name of Funding Body

Project Name

(if non-project, or ‘core’ funding, please state this)

Name of Grant Scheme (e.g. European Social Fund)

Amount

1.3.3 Since 1 January 2017, has your organisation received a qualified set of accounts? Please outline below. Suggested limit is 150 Words

1.4 Relevant experience

4.

1.4.1 Give a general overview of the main activities carried out / services provided by your organisation. Suggested limit is 200 Words

1.4.2 Does your organisation have any previous experience in delivering migrant or refugee integration projects?

|_| YesIf yes, include brief examples of such experience in the table below.

|_| NoIf no, move directly to Section 1.5.

Suggested limit is 200 Words

Section 2 Strength of Proposal

2.1 Project Details

1.

2.

3.

4.

5.

6.

2.1.1 What is the name of your project? Suggested limit is 10 Words

2.1.2 What is your project timeframe? Enter your project start date and end date and total in months. Please note that the minimum funding period for a project under this call is 24 months with a possible extension of 12 months. The latest start date for this project is 1st January 2021.

Start date (dd/mm/yyyy)

End date (dd/mm/yyyy)

In months

2.1.3 What is the geographical scope of your project? Please tick area(s) you wish to be considered for.

|_| Area 1

|_| Area 2

|_| Area 3

|_| Area 4

|_| Area 5

|_| Area 6

|_| Area 7

2.2 Project Plan

5.

1.

2.2.1 Outline the specific objectives of your project.

Overall objective of the project

2.2.2 Outcomes (Note: Please add more rows if required)

Outcomes

1

2

3

4

2.2.3 Project Actions and Outputs

Application Form Part Ia (2AMIF/03) sets out a Project Plan template to record the target outputs for the duration of the project. Please refer to the ‘Instructions’ Tab for information on how to complete this document. When completed Insert the Total Outputs from this document for each Project Outcome below. Please complete a separate table for each Project Outcome you have identified (Add more Project Outcome sections if required).

Project Outcome 1:

No.

Actions

Total Outputs (from Application Form Part Ia)

Estimated Cost

1.

2.

3.

4.

Please explain why you think these particular actions will deliver the project outcome.

Project Outcome 2:

No.

Actions


Estimated Cost

1.

2.

3.

4.


Project Outcome 3:

No.

Actions


Estimated Cost

1.

2.

3.

4.


Project Outcome 4:

No.

Actions


Estimated Cost

1.

2.

3.

4.


ISDAF 1

Application Form – Part 1

ISDAF 1


10 Call For Applications – 2020Integration Service Delivery


Section 3 Value for Money

3.1 Project Financials

2.

3.

4.

5.

6.

7.

8.

3.1.1 What is the total cost of your project? Only one Application Form Part II is necessary even if applying for more than one geographical area. The Estimated Budget amount entered for each geographical area in the Table below should match the total cost of the project as shown in Cell H13 of each ‘Application Form Part II’ tab of the Project budget document referenced ISDAF2

Area

Location

Estimated Budget (only complete for areas applied for)

1.

Dublin/Louth

2.

Cork/Kerry

3.

Limerick/Tipp/Clare

4.

Meath/Kildare/Wicklow/W’Meath/Offaly

5.

Waterford/Wexford/Kilkenny/Carlow/Laois

6.

Galway/Mayo/Longford/Roscommon

7.

Leitrim/Sligo/Cavan/Donegal/Monaghan

Total cost of your project

3.1.2 What are the direct salary costs associated with your project? You should provide details of all direct salary costs associated with the project. Justification must be provided for the salary costs being proposed by reference to relevant salary levels in the labour market.

Total number of project staff

Total direct salary costs

For each proposed member of project staff, please provide the following:

Proposed title of Position 1 (by reference to project)

Proposed salary

Salary scale

Full-time or Part-time staff member (E.g. Full time = 1.0, 3 day week = 0.6)

If part-time, provide salary costs of the project work only (timesheets must be kept)

Justification for salary level proposed

For any contract staff who may carry out some work on the project, (e.g. tutors/trainers), provide hourly rates and projected total costs.


Proposed salary

Salary scale






Proposed salary

Salary scale





Section 4: Applicant Declaration

I declare that I have the authority to represent [Name of Organisation] in making this application for funding under the Asylum, Migration and Integration Fund 2014 - 2020 (AMIF) to Integration Service Delivery Unit of the Department of Justice and Equality.

On behalf of the applicant organisation named at 1.1 above, I the undersigned, apply for AMIF funding to the value stated at 3.1.1 above for the project described in this application and declare that all the information given in this application is true and complete to the best of my knowledge and belief. I acknowledge that any funds awarded must be used only for the purpose stated and I acknowledge the right of the Department of Justice and Equality to seek the recovery of any funds that are not used for the purpose stated and in compliance with the grant agreement.

I also understand that information supplied in/or accompanying this application may be made available to Third Parties on request under the Freedom of Information Act 2014.

I confirm to the Department that I have informed all persons about whom I have provided personal information in this application of the details provided and the purposes for which this is to be used. I have the consent of the individuals to pass this information to the Department for these purposes.

I will inform the Department if, prior to AMIF funds being committed to the applicant organisation, I become aware of further information which may reasonably be considered as material to the Department in deciding whether to fund the application.

I, the undersigned, certify on my honour that the applicant organisation is not in one of the circumstances listed below which would exclude it from taking part in a Community grant programme, and I accordingly declare that the organisation:

· is not bankrupt or being wound up, is not having its affairs administered by the courts, has not entered into an arrangement with creditors or suspended business activities, and is not in any analogous situation arising from a similar procedure provided for in national legislation or regulations;

· has not been convicted of an offence concerning its professional conduct by a judgment which has the force of res judicata;

· has met its obligations relating to the payment of social security contributions or taxes under the legislation of the country in which it is established or with those of the country of the putative contracting authority or those of the country where the contract is to be performed;

· has not been the subject of a judgment which has the force of res judicata for fraud, corruption, involvement in a criminal organisation or any other illegal activity detrimental to the Community’s financial interests;

· is not currently subject to an administrative penalty;

· has not been declared to be in serious breach of contract for failure to comply with its contractual obligations subsequent to another procurement procedure or grant award procedure financed by the Community budget.

I have been informed that, under the Financial Regulation of 25 October 2012[footnoteRef:1] as last amended by Council Regulation No. 2015/1929 of 28 October 2015[footnoteRef:2], applicable to the general budget of the European Communities, contracts may not be awarded to candidates who, during the procedure: [1: Official Journal L 298, 26.10.2012, p. 1] [2: Official Journal L 286/1, 30.10.2015, p. 1.]

· are subject to a conflict of interest;

· are guilty of seriously misrepresenting the information required by the contracting authority as a condition of participation in the contract procedure or fail to supply this information.

I also accept, as a condition of the award of a grant, that it involves no commitment to any other grants under the AMIF or from the Department of Justice and Equality.

Each successful organisation will be required to sign a Grant Agreement with the Department of Justice and Equality setting out the terms and conditions of the grant.

Under section 42 of the Irish Human Rights and Equality Act, 2014, the Department of Justice and Equality has a positive legal duty to have regard to the need to eliminate discrimination, promote equality and protect the human rights of staff and persons to whom services are provided.

In accordance with this duty, the Department requires that the Grantee, in carrying out the project that is the subject of the Grant Agreement, have regard to the need to eliminate discrimination, promote equality and protect the human rights of staff and persons to whom services are provided. A condition in the Grant Agreement will reflect this requirement.

The applicant organisation is agreeable to have the project monitored by the Integration Service Delivery Unit of the Department of Justice and Equality, the AMIF Responsible Authority[footnoteRef:3], the AMIF Audit Authority[footnoteRef:4] and the EU auditors and to allow access to its premises and records, as necessary, for that purpose. [3: The AMIF Responsible Authority is the Funds Administration Unit in the Department of Justice and Equality] [4: The AMIF Audit Authority is the Department of Justice and Equality]

Name (BLOCK CAPITALS)

Signature_______________________

Position/title in organisation

Date

Section 5: Disclosure under the Freedom of Information Act

This Section should be signed by a person within the applicant organisation who has the authority to submit this application for AMIF funding.

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 Act 2014.

You are asked to consider if any of the information supplied by you in applying for funding under AMIF should not be disclosed because of sensitivity. If this is the case, you should, when providing the information, identify same and specify the reasons for its sensitivity below.


Signature_______________________


Date

Section 6: Disclaimer of Liability for the Application

This Section should be signed by a person within the applicant organisation who has the authority to submit this application for AMIF funding.

Please read carefully:

It will be a condition of any application for funding under the terms and conditions of AMIF, that the applicant has read, understood and accepted the following:

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.


Signature_______________________


Date

Section 7: Final checklist for applicants

|_| Have all applicable sections of this Application Form Part I - ISDAF1 (Word) been completed?

|_| Have you attached a completed Application Form Part II - Financial ISDAF2 (Excel) containing your project budget?

|_| Have you attached a copy of your audited accounts (if applicable) or income and expenditure statement for the past 3 years?

|_| Have you attached an organisation chart?

|_| Has the Declaration at Section 4 been signed and dated?

|_| Has the Disclosure at Section 5 been signed and dated?

|_| Has the Disclaimer at Section 6 been signed and dated?



Documents

Application form for funding under the Asylum, Migration and ... · Web viewApplication form for funding under the Asylum, Migration and Integration Fund 2014-2020 Keywords Asylum,