Measure 4 application form
MEASURE 4: Pre-Activation Supports for Female
Refugees and the Female Family Members of
Refugees
APPLICATIONS TO THE DORMANT ACCOUNTS FUND MUST BE MADE ONLINE
VIA THE POBAL WEBSITE
June 2017
THIS DOCUMENT IS FOR INFORMATION PURPOSES ONLY
DORMANT ACCOUNTS FUND
APPLICATION FORM
SECTION 1
Dormant Account Fund ELIGIBILITY
1.1 Insert the legal name of the organisation applying Enter name* Mandatory
for funding
WARNING: When you enter your organisation legal name and save your application form as draft you will not be able to
edit this field. Please ensure that you enter the correct name. Should you do this incorrectly, you will need to start a
new application form.
Options : Company Limited by Guarantee not having a Share
Capital, Company Limited by Guarantee having a Share Capital,
Friendly/Industrial Provident Society, Statutory Body, Association,
1.2 Please insert your organisation type.
Co-operative, A Designated Activity Company (DAC) Limited by
Shares, A Designated Activity Company (DAC) Limited by
Guarantee, A Company Limited by Guarantee, A Private
Charitable Trust, Other
1.2.1 CRO Number
Number (optional)
1.2.2 Enter your Charity Registration Number
Number (Note: this is not your CHY number, this is the number
issued to you by the Charities Regulator. (optional)
1.3 Please attach a copy of your 2016 signed
audited accounts.
Attach your recent signed 2016 audited accounts
Note:


If you have already submitted your audited accounts for 2016 to Pobal then you do not need attach them to this form
Statutory bodies do not need to attach their audited accounts
1.4 Enter the amount you are requesting.
€* Mandatory
The amount entered must be greater than €50,000
Refer to the application guidelines available on the Pobal website.
SECTION 2
Measure Specific Eligibility Criteria
Referring to the application guidance (hyperlink to the relevant page on the Pobal website and guidance notes),
please select the Dormant Accounts measure that you’re applying for:
(Only option Measure 4: Pre-Activation Supports for Female Refugees and the Female Family Members of
Refugees)
WARNING: When you select the measure and save the application form to draft, you will not be able to edit this field.
If you have selected the wrong measure, you will need to complete a new application form and follow the steps from
the beginning again.
MEASURE 4
THE FOLLOWING ELIGIBILITY CRITERIA QUESTIONS MUST BE COMPLETED IN FULL
2.1 Does your organisation and/or your project
partners have a track record of working directly with
refugees?
2.2 If yes to Q2.1, please provide a brief example(s)
of your organisation’s or your partners’ work with
refugees.
Option Yes/No
Maximum 500 characters
Note:
Please provide a short, concise answer that explains how your organisation/partnership has worked
directly with refugees. For example:
- We have managed a drop-in centre for migrants since 2006. Approximately 100 of our clients are
refugees.
- We delivered a six month English and ICT training course to refugees aged in 2010.
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SECTION 3 ORGANISATION DETAILS
NOTE: IF YOU ARE APPLYING AS A PARTNERSHIP, THIS SECTION OF THE APPLICATION FORM MUST BE COMPLETED BY THE
LEAD PARTNER ONLY
3.1 Legal Name of the Organisation
Pre-fills from 1.1
WARNING: When you enter your organisation legal name and save your application form as draft you will not be able
to edit this field. Please ensure that you enter the correct name. Should you do this incorrectly, you will need to start
a new application form.
3.2 Does your organisation currently
have a grant agreement/contract with
Y/N Mandatory
Pobal?
3.2.1 If Yes, please insert your
Mandatory if yes
URN/Grant ID Number
3.3 Provide your Business Name if
different from your Legal Name at
Optional
Question 3.1 above
Mandatory
3.4 Provide your Organisation
Address (include EIRCODE)
3.5 Organisation Website Address
Optional
3.6 Tax Registration Number
Optional
3.7 Enter your TCAN (Tax Clearance
Access Number)
Optional
Attach evidence of your TCAN from revenue e.g. letter or e-mail from
revenue.
3.8 Primary Contact Information
Nominate the person who can be contacted in relation to this application. Please provide the following details:
Name
Job Title/Role within the Organisation
Main Phone Number
Mobile Phone Number
E-Mail Address
3.9 Chairperson Contact Details
2
Name
Job Title/Role within the Organisation
Main Phone Number
Mobile Phone Number
E-Mail Address
3.10 Attach a copy of your
Memorandum and Articles of
Association or relevant governing
document
Attach governing documents
3.11 Is your organisation affiliated to
or part of another organisation?
Options yes/no
3.12 If Yes, please explain.
3.16 Governance Arrangements
Name of Board Member
Position on Board
Representative Of:
(Target
Group/Organisation/Sector)
3.16.1 Please provide us with
details of your current Board of
Directors.
3.16.2 How often does your Board
meet?
3.16.3 Have you any subcommittees in place? Y/N
Tick One of the Following:
Once a Month
Bi-Monthly
Bi-Annually
Annually
Other
Please explain other- if
selected
Options yes or no
3
Please enter N/A in any fields that are not applicable to you.
Sub-Committee
3.16.4 If you answered ‘Yes’ to
Q3.16.3, please complete the
following table for the relevant subcommittees you have in place.
1
Audit/Finance
Sub-Committee
2
Human
Resource/Staff
Committee
Marketing and/or
Publicity
Committee
3
Purpose/Role of the SubCommittee
How often does the
Sub-Committee
report to the Board
/Management
Committee?
For example:
Weekly, Monthly,
Quarterly, BiAnnual, Annually
4
Facilities/Specifi
c Service
Committee
Other; please
explain
5
3.16.5 Has your organisation put in place a governance code or standards of practice?
For information please go to www.governance.ie
Please note that this answer is for information purposes only.
Y/N
13.6.6 If Yes, please provide details of the code or standards of practice.
Text – maximum characters =8,000
3.17 Staffing arrangements
3.17 How many staff are currently
employed in your organisation?
Note: If you do not currently employ
staff please enter zero (0) in the table
Number of Full Time Staff
Number of Part Time Staff
3.18 Volunteers
3.18 How many volunteers are
involved in your organisation? Do
not include board members in your
response.
Note: If you do not have volunteers
enter zero (0).
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3.19
Previous experience in managing funding
3.19.1 What are your procedures and controls to ensure good financial management?
3.19.2 In the table below, please provide details of EU or exchequer funding that you have managed in the last
three years. Only grants that are relevant to this application should be listed below.
Funder Name
Year Funding
Awarded
Programme
Amount
Awarded
SECTION 4 PROJECT PROPOSAL
Hyper-link to the applicant guidelines
Please refer to the guidelines which will provide you with more detail on the sort of information we are looking for in these
questions.
4.1 Please provide a short summary of the project you plan to deliver with Dormant Accounts funding.
Note: If you are successful, we may use this information in any publicity we produce about your project
Maximum 5,000 characters
4.2.1 What is the aim of your project?
Maximum 500 characters
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4.2.2 List the objectives, related actions and areas where these actions will be delivered during the
lifetime of your proposed project
Objective
Actions
Timeframe
From – To
(Please name
month and
year)
NOTE: A minimum
of 1 project
objective must be
outlined in the
table.
NOTE: Each
project objective
must have at least
one
corresponding
action.
FAO ICT: Table
must facilitate 5
objectives.
Applicant must enter
a minimum of 1
project objective.
FAO ICT: There
should be a
minimum of one
action for each
corresponding
objective. There
should be no more
than 5 actions to
achieve each
objective.
Free Text
Maximum 500
characters
Free Text
Maximum 500
characters
1.
Organisation
with
responsibility
for delivery
Name the
city/cities
and/or
county/counties
where each
action will
take place
Name the
locality/to
wn where
each
action will
take place
NOTE: This
column should
only be filled
out for
partnership
applications.
FAO ICT:
Answers should
be inputted in a
month and year
format e.g.
Dec 2017-Jul 2018.
A timeframe
must be
provided for
each action.
FAO ICT:
Optional.
Free Text
Maximum 100
characters
FAO ICT:
Drop Down
Box for Cities
and Counties.
FAO ICT:
Free text.
Text must
be entered
for each
action.
A city/county
must be
selected for
each action.
Free text
Applicants
should be able
to select more
than one city
or county for
each action if
required.
Maximum
500
characters
for each
text box.
a.
b
c.
d.
e.
2.
a.
b
c.
d.
e.
3.
a.
6
b
c.
d.
e.
4.
a.
b
c.
d.
e.
5.
a.
b
c.
d.
e.
4.2.3 Explain how you plan to deliver the key actions
In answering this question,
(a) Explain who will be responsible in your organisation, for managing and
delivering the actions outlined, including justification for any new role which
will be supported by DAF funding and
(b) Explain how partners or other key stakeholders, will be involved in the
delivery of the actions outlined.
Maximum 8,000 characters
4.2.4 Who will participate in your project? Please provide specific detail about the group of female refugees
that you propose to work with.
Maximum 8,000 characters
4.2.5 How will your project recruit and engage with this group of participants?
Maximum 8,000 characters
4.3 Explain the need for this project. In your response:
Maximum 8,000 characters
Please provide specific examples of how your organisation identified
that there was a need for this project and how you identified the gender
specific needs of this target group through:
- Evidence based research
- Objective data
- Anecdotal evidence based on work with the target group,
and/or
- Consultation with the target group
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4.4 MEASURE OUTPUTS and OUTCOMES
Detail the expected outputs and outcomes for your project proposal, using the table below. Your response must include
at least one of the measure outputs and outcomes included in the application guidelines.
Explanatory Notes:
1. When you select an output from the dropdown list it is mandatory for you to enter a number under the target for
each output. This should be a realistic and achievable figure.
2. When you select an output you must select an outcome from the dropdown list that your output will contribute
to. You may select the same outcome for a number of outputs.
3. When you select an outcome you are also asked to provide a target. The target should be realistic and
achievable. The target inserted for the outcome may be less than output target. For example, 40 individuals
will have attended pre-activation coaching however the corresponding outcome may be that 25 are ready for
new learning and training.
Measure Outputs
Applicants must select a
minimum of two outputs.
The first output: 'Total
number of females
supported by the
measure' is mandatory.
FAO: ICT
Dropdown options below.
Applicants must select a
minimum of two outputs.
The first output listed is
mandatory.
 Number of females
supported by the
measure (mandatory)
 Number of females
participating in nonaccredited initiatives
that focus on
confidence building
and other soft skills
(optional)
 Number of females
participating in work
experience initiatives
(optional)

Number of females
supported to engage
with mainstream
employment services
(optional)
Target Numbers for Each
Output
Measure Outcomes
Applicants must enter
a whole number for
each of the measure
outputs selected.
FAO: ICT:
Whole Numbers only. A
whole number must be
entered for each output
selected by the applicant.
Applicants must select a
minimum of one
outcome.
FAO: ICT
Dropdown options below.
Applicants must select a
minimum of one outcome.

Whole number





Number of females
progressing to nonaccredited
training/education
courses
Number of females
progressing to
accredited
training/education
courses
Number of females
progressing to
volunteering roles
Number of females
progressing to parttime employment
Number of females
progressing to full-time
employment
Number of females
progressing to selfemployment
Target Numbers for Each
Outcome
Applicants must enter
a whole number for
each of the measure
outcomes selected.
FAO: ICT:
Dropdown options below.
Applicants must select a
minimum of one outcome.
Whole number
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4.5 MEETING THE MEASURE CRITERIA
Explain concisely how your project will meet the measure criteria as outlined in the guidelines.
4.5.1 Provide examples of your organisation’s and/or your partners’ track record of working directly with
refugees.
Please highlight any previous initiatives that targeted female refugees and/or focused on provision of
education, training or employment supports to refugees.
Maximum 8,000 characters
4.5.2 Explain how your organisation identified the specific cohort of the target group for this project.
Maximum 8,000 characters
4.5.3 Explain how your proposal meets the gender specific needs of female refugees.
Maximum 8,000 characters
4.5.4 Explain why your project is realistic and achievable within the project timeframe.
Maximum 8,000 characters
4.5.5 Explain how your project is additional to mainstream funding supports for refugees.
Maximum 8,000 characters
4.5.6 Explain why your proposal is not possible without Dormant Accounts Funding.
Maximum 8,000 characters
4.6 PARTNER/(S)
If your project involves a partner/partners, please explain how they will be involved in the management and
delivery of your project. Please include a brief summary of their relevant expertise.
Maximum 8,000 characters
4.7 SUSTAINABILITY
Outline the learning and any actions which could be sustained beyond the end date of your project.
Maximum 8,000 characters
4.8 MONITORING
How will you monitor and record progress in relation to your project?
Maximum 5,000 characters
4.9 ANY OTHER RELEVANT INFORMATION
Please provide any other information which you think is relevant to this application
Maximum 5,000 characters
Facility to attach relevant supporting documents (not mandatory)
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SECTION 5
FINANCES
5.1 What is the total cost of your project
5.2 What is the grant amount you are seeking
from the Dormant Accounts Fund?
5.3 If the project costs are greater than the amount
applied for, please explain how you will fund the
additional costs.
€
€ 5.2 may equal 5.1.
Amount cannot be less than €50,000
Maximum 8,000 characters
VAT
5.4 IS your organisation registered for VAT?
5.4.1 If yes, is the VAT recoverable for the costs
included in this project?
5.4.2 If no, complete the VAT Not Recoverable
template
Y/N
Y/N
Attach VAT Not Recoverable template
Hyperlink to VAT not recoverable template
If Yes to Q5.4 VAT must be excluded from the costs outlined in the Budget Template.
5.5 What is the proposed start date for your
project?
5.6 What is your proposed end date for the
project?
The earliest start date for projects will be _______
and the latest end date will be _______. Your
project can start or finish anytime between these
dates.
5.7 PROJECT BUDGET
Download and complete the budget template
(Hyperlink to the budget template)

Attach budget template
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SECTION 6
Disclaimers
A. Disclosure under the Freedom of Information Act
Under the Freedom of Information Act 2014, the information in this application form and its attachments may
be released on request to third parties.
If you believe that any of the information in your application form is sensitive and should not be disclosed to a
third party, you must identify the sensitive information and provide the reason(s) for its sensitivity.
You will be consulted about the sensitive information before any decision is made to release the information to
a third party.
Please outline the sensitive information and the reason(s) for the sensitivity in the text box below.
Text box (maximum 1,500 characters). Optional.
B. Data Protection
In submitting this application to Pobal, your organisation (and project partners) agree that:

No sensitive personal data should be included on this form.
Sensitive personal data is defined as data relating to a person's racial origin; political opinions or religious
or other beliefs; physical or mental health; sexual life; criminal convictions or the alleged commission of an
offence; trade union membership. In this case, sensitive personal data may also refer to the inclusion of
names, addresses and/or ages of service users or project beneficiaries in your application form.

Your organisation authorises Pobal to use, process and store the information in this form for the purposes
of assessing your proposal for funding, the administration of any grants awarded by the Dormant Accounts
Fund and the production of internal and external reports relating to the Dormant Accounts Fund.

In its management of the Dormant Accounts Fund scheme, Pobal may transfer any data it has received
from, and any data it holds relating to your organisation to other persons and bodies, such as the
Department of Arts, Heritage, Regional, Rural and Gaeltacht Affairs, the Department of Social Protection or
the Department of Justice and Equality or any other Government Departments sponsoring the Dormant
Accounts Fund.

If a third party is acting on your organisation’s behalf, Pobal is authorised to use, process and store data
received from this third party and to forward to the third party, any data relating to your application, Pobal’s
appraisal of your application and your organisation’s delivery of projects supported by the Dormant
Accounts Fund. Pobal may also procure data from third parties to assess your application.

It is your organisation’s responsibility to ensure that any sensitive personal data submitted is obtained with
the individual’s consent and knowledge that the data will be used for the purposes of this application. By
submitting this application form, your organisation confirms that consent has been obtained from any
individual whose data is disclosed within the application form.
Tick box to confirm that you have read and agree with the above data protection requirements.
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SECTION 7
SUBMISSION OF APPLICATION
Please read carefully before submitting your application.
The board of directors or management committee, by submitting this application:
 Confirms that the application form and attached documents is submitted on their behalf;
 Declares that the information provided in the application form and attached documents are true and
accurate;
 Accepts that Pobal may contact funding organisations or government departments to discuss this
application and previous funding awarded, as part of the selection process;
 Has the co-funding in place as described in the application form (if applicable);
 Has a current lease or agreement in place with the owner of the property (if applicable);
 Has the consent of the legal owner of the premises to carry out any refurbishment or to install
machinery (if applicable);
 Has planning permission or has applied for planning permission to carry out any refurbishment
included in this application (if applicable);
 Accepts that the Department of Arts, Heritage, Regional, Rural and Gaeltacht Affairs, the Department
of Social Protection, the Department of Justice and Equality or Pobal 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 any application.
 Accepts that the Department of Arts, Heritage, Regional, Rural and Gaeltacht Affairs, the Department
of Social Protection, the Department of Justice and Equality or Pobal, their servants or agents, shall
not at any time or in any circumstances, be held responsible or liable in relation to any matter
whatsoever arising in connection with the development, planning, construction, operation,
management and or administration of an individual project.
7.1
NAME
7.2
POSITION ON THE BOARD
ACCEPTABLE USE AND PRIVACY STATEMENT – hyperlink to the Pobal policy on our website which outlines
conditions re using online forms and information provided on line.
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