Measure To Support The Employment of People With Disabilities

Measure to
Support the Employment of

People with Disabilities
Grant Application Form

April 2021
1
Section 1 Useful Information
_______________________________________________________________________________
Before you fill in this application form:

 Save a copy of the application form to your own computer as a Word
Document - please do not PDF the final completed form.
 Read the application guidelines. These guidelines describe who can
apply, what actions and costs are eligible and how we will appraise
your application.
The guidelines are available on the Pobal website:

www.pobal.ie
 Note the space available to respond to each question. A word limit

has been indicated on some questions as a guide only.
 You are required to complete all questions. Exceptions are marked
as “optional”.
Any Questions?
If you have any questions in relation to this application form, please
contact a member of our team.
 E-mail: onlinesupport@pobal.ie
 Tel: 01 5117222
Useful Information
Our website has further information and advice on how to make a
successful application.
Preparing to apply for funding
https://www.pobal.ie/app/uploads/2019/04/Pobal-Brochure-1-Planning-an-
Application-web.pdf
Writing an Application
https://www.pobal.ie/app/uploads/2019/04/Pobal-Brochure-2-Writing-an-
Application-web.pdf
2
Section 2 Eligibility Criteria
Eligibility Criteria 1: Legal Status in the Republic of Ireland
1.1 What is the full legal name of your organisation?
This is the name shown on your governing documents and or your legal documents for
your organisation
This information is specific to the organisation which will enter into a grant agreement with Pobal
should this application be successful. This organisation is accountable for the expenditure and
implementation of the proposed project.
If you are applying as part of a partnership or consortium, a lead applicant must be identified.
Only the “lead applicant’s” information should be provided in Questions 1, 2 and 3.
Click or tap here to enter text.
1.2 Does your organisation have a different business name that you use for your
day to day work? Click here to choose Yes or No
If yes, please provide your business name (optional)
1.3 Pobal Unique Reference Number (optional)

If you have a grant agreement or contract with Pobal please provide your Unique Reference
Number (URN). You will find this number on your current grant agreement or correspondence from
Pobal. Please leave blank if you have not received a grant from Pobal.
3
Eligibility Criteria 2: Relevant experience
2.1 Please provide a concise summary of your organisation’s direct experience in

supporting and or providing services to People with Disabilities.
To be eligible for consideration your organisation must demonstrate that it has at least three years
relevant experience/strong track record supporting and engaging and working with People with
Disabilities.
For applications involving two or more organisations:
Please outline the relevant experience of each organisation. In your response include the name of
your partner and their relevant experience. To be eligible for consideration at least one of the
partner organisations must have the 3 years relevant experience supporting and engaging directly
with People with Disabilities. 500 word limit (continue on next page if required)
4
2.1 Continued…
5
Section 3 Your Organisation
_______________________________________________________________________________
3.1 Please provide the following information about your organisation.

Your Address, EIRCODE, TRN and TCAN are mandatory.
Organisation Address Address Line 1
Address Line 2
Address Line 3
Address Line 4
County
EIRCODE https://www.eircode.ie/ Eircode
Website Address Website
Companies Registration Number (CRO) CRO

Issued by the Companies Registration Office
https://www.cro.ie/en-ie/
Registration Number Registration No.

Issued by the Registry of Friendly Societies
https://www.cro.ie/Society-
Union/Overview
Tax Registration Number (TRN) TRN
This number is issued by Revenue
https://www.revenue.ie/en/online-
services/index.aspx
Tax Clearance Access Number (TCAN) TCAN

This number is issued by Revenue
CHY number CHY
This number is issued by the Revenue.
https://www.revenue.ie/en/search.aspx?
q=CHY%20Number
Registered Charity Number (RCN) RCN
This number is issued by the Charities
Regulator in Ireland.
https://www.charitiesregulator.ie/en
6
3.2 Your contacts
We require contact information for two different people in your organisation involved in this
application for funding.
a) A main contact, i.e. the people we can contact on behalf of your organisation in relation to
this application.
b) Chairperson’s contact details, i.e. the person legally responsible and accountable for this
application and any subsequent grant agreements (contract).
Main Contact Chairperson
Name First Name & Last Name First Name & Last Name
Role/Job Role/Job Title Role/Job Title
E-mail
Title Email Email
Telephone Landline Landline
Mobile Mobile
7
About your organisation
3.3 Provide a concise overview of your organisation’s objectives and key

achievements during the past three years.
Please include information on those who avail of the Organisation's programmes and activities,
including (where available) information on the background of beneficiaries.
e.g. disability type, age, gender, and geographical. 500 word limit
8
3.4 Provide a summary of relevant Exchequer, EU or philanthropic funding that your
organisation has been awarded and directly managed over the previous three
years.
Please ensure that you provide information on any current funding from the Department of
Social Protection.
Year Funder Programme Period of Amount Brief description of the

Awarded Funding Awarded purpose of the funding
€
Year Funder Programme No. of Yrs Amount Click or tap here to enter
& Months text.
& Months text.
& Months text.
& Months text.
& Months text.
9
Your governance arrangements
3.5 How is your organisation’s board comprised? How many board members are
there? Please also outline any relevant expertise your board members may
have.
For example, expertise and specialist knowledge of working with and supporting People with
disabilities, managing and delivering similar projects, managing and reporting on grants or funding
from public bodies, managing staff etc. 350 word limit
3.6 How often does your board meet each year?
Choose an item.
Please briefly explain, if you have chosen “Other”.
10
3.7 Does your board have any sub-committees? Click here to select
If yes, please provide the name of each sub-committee, their main function and how often each
sub-committee reports to the board. 250 word limit
3.8 Has your organisation adopted a governance code? Click here to select
If yes, please provide details.

If your organisation is in the process of adopting a governance code, please provide details of
the code and progress to date. 250 word limit
11
3.9 Provide a summary of your organisation’s financial controls, policies and

procedures. 500 word limit
12
13
Section 4 Your Project
4.1 Enter the title for this new project.
Please note that this will be used for publicity purposes.
4.2 Enter Start Date for your project.
Enter End Date for your project. end date
Note: Projects must be ready to commence by 1st September 2021 and be completed
no later than 31st December 2022.
4.3 Describe your project in 50 words or less

This will be used for future publicity materials should your application be successful. Briefly and
clearly explain the proposed project, describe who and how many will benefit. The reader should be
able to understand the project from reading the project summary.
14
4.4 Estimate the total number of individuals that you expect to directly benefit from
your project’s activities. You must enter a figure in the box below.
Direct beneficiaries are individuals who primarily benefit from project interventions. It is important to
note that primary beneficiaries are directly connected with project outputs and outcomes, and
should be easily identified and described.
Number of People with Disabilities
Indirect beneficiaries - Please list and insert number of individuals for any other target
group.
An indirect beneficiary is someone who is not directly connected with the project but will still benefit
from it. This could be other members of the community or from the area or family members of the
participants.

**
Indirect Beneficiary Total : Expression
is faulty **0
4.5 Indicate the geographical areas that the direct beneficiaries that you are
targeting for this project are most likely to live. For example, county, city, town,
village, rural or urban area. 100 word limit
15
4.6 Joint applications (optional)
If you are delivering your project with a partner(s), list your partners and describe the governance
and oversight arrangements for the delivery of the project.
Clearly justify what the partnership(s) will offer and why. This should include an explanation of how
the partnership will function, for instance whether partners are providing technical advice and/or
delivering activities and whether there will be capacity building within the partnership. 500 word limit.
16
4.7 List your project’s outcomes, outputs and targets, activities, inputs and
assumptions/ risks.
Please read these instructions carefully before completing the table below.
Number of Actions
There is the facility to include up to 5 Actions for your project on this form.
Requirements
 You must complete at least one action.
 Each action can be broken down to a maximum of 6 activities.
(You must have a minimum of 1 activity per action).
 You must select only one outcome per action.
 You must select up to two outputs per action.
 For each output you must insert a target number.
At least one of your actions must be linked to the following outcome and
output:
 Outcome: Increased labour market participation of People with Disabilities.
 Output: Number of People with Disabilities progressing to paid employment.
 A target number must be inserted against the output.
Note: If you require to add additional actions, please copy these tables into a
Word document and upload to the Portal with your application form.
17
Action Table Explanation & Example
Outcome Output Output Key activities Inputs Assumptions/Risks
Target
The effect which is The direct/tangible results Number Constitutes the strategies and Resources that the External factors that
expected to be that the project delivers. activities to achieve the project consumes in could have an
achieved as the result outputs and outcomes. the course of influence, whether
of the project delivering undertaking the positive or negative, on
the planned outputs. activities. the delivery of the
More specifically, the project.
expected benefits to
the target group(s).
Workshops, meetings, deliver Staff, money, time,

Availability of
Select from drop-down Select from drop-down services, develop products equipment,
Insert numeric participants, retention
menu. menu. (curriculums, resources), materials,
value. of staff through project
purchase equipment, training, partnerships,
timeframe etc.
facilitate, partner etc. research etc.
Example:
Increased labour Number of People with 15 • Provide practical training on  A part-time  Required
market participation of Disabilities progressing to the world of work to each consultant with consultants are
people with disabilities paid employment participant. expertise in available.
• Liaise with businesses to recruitment and  Employers are
Number of People with 2 provide work experience disability. supportive.
Disabilities benefitting from opportunities.  Staff time for  External
progression in employment • Support each participant organisation and environment is
during their work experience delivery of conducive (Covid-
and identify and overcome project. 19 lockdown etc.)
challenges.  Financial
• Carry out a review of the resources for the
work experience module. purchase of
• Identify if further materials and
skills/training is required after equipment.
the work experience review.
18
Please complete the tables below
Action 1
Target
Increased labour market participation
Number
of people
of People
withwith
disabilities Click to enter
Disabilities progressing Click or
to paid employment tap here to enter Click or tap here to Click or tap here to
numeric text. enter text. enter text.
value only
Choose Output 2 Click to enter
numeric
value only
19
Action 2
Target
Choose an item. Choose Output 1 Click to enter Click or tap here to enter Click or tap here to Click or tap here to
value only
numeric
value only
20
Action 3
Target
value only
numeric
value only
21
Action 4
Target
value only
numeric
value only
22
Action 5
Target
value only
numeric
value only
23
4.8 Risks
Outline any key organisation risks or challenges you have identified in relation to delivery of your
project, including any mitigations to reduce the risks identified.
500 word limit
24
4.9 Need
Explain how you identified the need for this project.
Reference any relevant and recent (in the last 3-5 years) experiences where your organisation has
been engaging or working with the target group(s) for this application. In addition you may
reference evaluations, research, reports or other supporting materials to evidence the needs you
are outlining e.g. include webpage addresses or hyperlinks where possible. 250 word limit
Explain why your organisation needs a grant from the Dormant Account Fund to
undertake this project. 250 word limit
25
4.10 Explain how your project is additional to current services and supports being
provided in your area for People with Disabilities by statutory bodies,
community and voluntary organisations or charities.
Outline what steps you have taken to ensure your project is not duplicating any other services or
supports currently available for People with Disabilities. 250 word limit
4.11 Outline how you have considered and addressed the impact of COVID-19 on
your project.
In your answer you should address both how the project will support your target group’s needs in
this new context, as well as how you intend to carry out the project within the parameters of the
current public health emergency. 250 word limit
26
4.12 Explain how your project activities will assist People with Disabilities to
engage with the labour market and / or training and education opportunities.
Include in your response how the project will improve their employability. 500 word limit
27
4.13 Explain how your project activities are in line with relevant government policies
and strategies e.g. National Disability Strategy and Implementation Plan 2013;
Comprehensive Employment Strategy for People with Disabilities 2015-2024,
National Disability Inclusion Strategy 2017-2021, Roadmap for Social Inclusion 2020-
2025 Ambition, Goals, Commitments. 250 word limit
4.14 Explain the potential of your project to be sustained, replicated or expanded in

the future. What options or opportunities are there for your organisation to continue the
project actions after the funding is ceased? 250 word limit
28
4.15 How will your board or management committee monitor this project to ensure
that it is delivered on time, within budget and the anticipated outputs and
outcomes are achieved? 250 word limit
Outline the processes & tools that your organisation will use to monitor your project.
Outline your board/committee’s oversight and management arrangements for the

project. 250 word limit
29
Section 5 Project Budget
5.1 Is your organisation registered for VAT? Click here to choose Yes or No
If your organisation is registered for Value Added Tax (VAT), the amount of grant awarded will
be net of VAT. The figures entered in this section of the application form must not include the
VAT amounts.
If you are registered for VAT and any of the costs included in your project budget are inclusive of
VAT because you cannot reclaim VAT on the items included in the budget, please complete
the VAT Not Recoverable template.
If your organisation is not registered for VAT i.e. your organisation cannot claim the VAT back
from Revenue, the figures entered in this section of the application form are the costs
including VAT.
5.2 Complete the budget tables.
Project Costs
Important information
 Read the application guidelines in advance of completing the budget tables.
The application guidelines provide you with information on eligible and ineligible
costs.
 Insert whole numbers only, do not insert cents or decimal places
 Each time you insert or delete a numeric value in the table below please
ensure that you click in a different numeric cell in this table to refresh the
total. This is particularly important in the last cell of each table.
Note that clicking directly into cells to add or edit an entry rather than
tabbing provides best user experience.
 If you have made an error when entering a numeric value, to amend it please
highlight the value and delete it, before re-entering correctly.
 Remember to provide a clear explanation i.e. details of how you arrived at the cost
or the basis for each cost e.g. salary pay scales, rate per hour or per day for a
service such as room hire; travel and subsistence rates for your organisation.
30
31
Budget
Enter the amount of grant applied for: €
Direct Employment Costs
2021 2022 Explanation
Total
Cost (Sept-Dec) (Jan-Dec) You must insert an explanation for each cost
€
€ €
Employee 1 ** Click or tap here to enter text.
Salaries (incl. PRSI and Pension) Expression
is faulty **0
is faulty **0
is faulty **0
is faulty **0
Travel and Subsistence ** Click or tap here to enter text.
Expression
is faulty **0
Recruitment ** Click or tap here to enter text.
Expression
is faulty **0
Staff Training ** Click or tap here to enter text.
Expression
is faulty **0
Click or tap here to enter text. ** Click or tap here to enter text.
Expression
is faulty **0
Expression
32
is faulty **0
Expression
is faulty **0
Total Direct Employment Costs ** ** 00
Expressio Expressio
n is faulty n is faulty
**0 **0
Equipment Costs for Staff

Cost (Sept- (Jan-Dec) Total You must insert an explanation for each cost
Dec) € €
€
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Total Equipment Costs ** ** 00
Expressio Expressio
**0 **0
Direct Programme Costs

Cost 2021 2022 Total Explanation
(Sept- (Jan-Dec) € You must insert an explanation for each cost
33
Dec) €
€
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Total Direct Programme Costs ** ** 00
Expressio Expressio
34
**0 **0
Assistive Technology or Equipment Costs

(Sept- (Jan-Dec) Total You must insert an explanation for each cost
Cost
Dec) € €
€
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Total Assistive Technology / ** ** 00
Equipment Costs Expressio Expressio
**0 **0
35
Indirect Costs (Max 10% of total Direct Costs)

(Sept- (Jan-Dec) Total You must insert an explanation for each cost
Cost
Dec) € €
€
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Expression
is faulty **0
Total Indirect Costs ** ** 00
Expressio Expressio
**0 **0
TOTAL COSTS
Direct Employment Costs € **
Expressio
n is faulty
**0
36
Employee Equipment Costs € ** Expression
is faulty **0
Direct Programme Costs € ** Expression
is faulty **0
Assistive Technology or Equipment € ** Expression
is faulty **0
Total Direct Costs € 00
Total Indirect Costs € ** Expression
is faulty **0
Indirect costs as a % of direct costs (Max 10%): ** Expression
is faulty **
%
TOTAL COSTS € ** Expression
is faulty **0
37
5.3 Please complete the table below
Enter whole numbers –no decimals
Total Cost Grant Requested Own Funds

€ € €
Applicants can apply for up to 100% of the eligible costs for the project.
5.4 If the total costs are greater than the maximum grant available or the amount of grant applied for, please explain how you
intend to fund the additional costs.
If your application is successful you will be required to provide evidence of the additional funding before you receive your first payment.
38
5.5 What are the project’s major costs categories and what actions will you take to control those costs? What is the
project cost per beneficiary? 300 word limit
5.6 Are the inputs and activities you have chosen relevant, robust and cost effective to deliver the outputs and
outcomes? 300 word limit
39
Section 6 Any Additional Information
6.1 Is there any other relevant information to support your application?
You may include any further information to support your application on this page. If the
information relates to a specific question in the application form please ensure you
reference the question number.
40
Section 7 Terms, Conditions and
Disclaimers
_______________________________________________________________________________
Terms and Conditions

1. By submitting the application, the Board of Directors/Management Board declare that
the information provided in relation to the organisation described in this application is
true and complete to the best of their knowledge and belief.
2. The grant must only be used for the agreed purposes in accordance with the application
guidelines and the terms and conditions outlined in this application form.
3. It will be a condition of any application for funding under the terms and conditions
that:
i. DSP, DRCD and 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.
ii. DSP, DRCD, Pobal and their servants or agents shall not at any time 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 individual projects.
4. By submitting this application the Board of Directors/Management Board acknowledges

that they have read, understood and accepted the above terms and conditions and the
registered user for the online Dormant Accounts Fund Portal has the permission of the
board to submit this application for funding on their behalf.
Please confirm that you have read and understood these conditions
by checking this box.
41
Disclaimers
Please read carefully:
The Board of Directors/Management Board acknowledges that any grant awarded must be used
for the purpose stated and not used to replace existing funding.
The Board also understands that information supplied in, or accompanying, this application may
be made available on request under the Freedom of Information Acts 2014.
The Board accepts, as a condition of the award of a grant, that it involves no commitment to any
other grants from the Government of Ireland, Department of Social Protection (DSP) and/or
Pobal.
The Board of Directors/Management Board also accepts that Pobal may contact other Funder
Organisations or Government Departments in relation to this application and previous funding
awarded, as part of the decision making process.
Disclosure under the Freedom of Information

Under the Freedom of Information Act 2014, the information in this document and its attachments
may be released on request to third parties.
If you believe that any of the information in this document 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 at the time of the application.
You will be consulted about the sensitive information before any decision is made to release the
information to a third party.
If you do not identify any of the information supplied in this document and supporting
documentation as being sensitive you are acknowledging that any, or all of the information
supplied, may be released in response to a Freedom of Information request.
Please outline the sensitive information and the reason(s) for the sensitivity in the text box
below.
42
43
Lobbying Act 2015
Under the Lobbying Act 2015, applicants should note that DSP, DRCD and Pobal are
required to make information available to the public on the identity of those communicating
with us in relation to prospective funding decisions.
Canvassing by an applicant or a third party may disqualify an application
General Data Protection Regulations (GDPR)

Pobal is responsible for the administration and delivery of “Measure to Support the
Employment of People with Disabilities” on behalf of the Department of Social Protection
(DSP).
Pobal is a data processor on behalf of Department of Social Protection (DSP).
We are committed to protecting and respecting your privacy. We respect your trust in us. To
fulfil our regulatory and statutory obligations, we will collect some personal information from
you, such as your contact information and details of your board members and staffing
resources. We may share your information with the DSP and other departments who are
the data controllers for the Dormant Accounts Fund.
We use information about you:
 To process a grant application.
 As part of the decision making process DSP and Pobal will share information
with DRCD
 To carry out our obligations arising from our contract for administering the Dormant
Accounts Fund on behalf of DSP
 To notify you of any changes relevant to any funding agreement (contract)
 To send you communications relevant to your grant agreement (contract)
 To collect and analyse programme data and demographic information to enhance
service delivery and support government policy
 To seek your views or comments on the supports we provide.
In addition, The Government of Ireland, DSP and DRCD may use the data in this
application form as part of research or documenting the impact of the grant awarded under
the Dormant Accounts Fund.
In compliance with GDPR, all application forms and personal information submitted to
Pobal will be kept only for purposes relating to the administration of the funding. We will
hold your personal information on our systems for as long as is necessary for the relevant
activity, or for as long as is set out in any relevant contract you hold with us. This is subject
to legislation and regulatory rules we must follow as set out by DRCD and DSP.
Pobal takes our security responsibilities seriously, employing the most appropriate
administrative, physical and technical measures to safeguard your personal data, and
regularly review these measures.
44
Personal data should not be disclosed within this application form for any reason
incompatible with the purpose for which funding is sought. Furthermore, any individual
whose personal data is submitted within this form must be informed of the use of their
personal data. By submitting this application form you are confirming individuals whose
personal data is disclosed have been clearly informed of this purpose and have been
informed of their rights under data protection legislation.
For more information on your privacy rights, please see our full Privacy Statement on our
website.
Please confirm that that you have read and understood the Disclaimers set out in this
application form.
1. The grant can only be used for the purposes set out in this application form. ☐
2. Disclosure under the Freedom of Information Act 2014. ☐
3. Lobbying Act 2015. ☐
4. General Data Protection Regulations (GDPR). ☐
45

Measure To Support The Employment of People With Disabilities

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Measure To Support The Employment of People With Disabilities

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Measure to

Support the Employment of

Grant Application Form

Before you fill in this application form:

The guidelines are available on the Pobal website:

 Note the space available to respond to each question. A word limit

1.1 What is the full legal name of your organisation?

Click or tap here to enter text.

If yes, please provide your business name (optional)

Click or tap here to enter text.

1.3 Pobal Unique Reference Number (optional)

Click or tap here to enter text.

2.1 Please provide a concise summary of your organisation’s direct experience in

Click or tap here to enter text.

3.1 Please provide the following information about your organisation.

Organisation Address Address Line 1

EIRCODE https://www.eircode.ie/ Eircode

Website Address Website

Companies Registration Number (CRO) CRO

Registration Number Registration No.

Tax Clearance Access Number (TCAN) TCAN

Main Contact Chairperson

3.3 Provide a concise overview of your organisation’s objectives and key

Click or tap here to enter text.

Year Funder Programme Period of Amount Brief description of the

Click or tap here to enter text.

3.6 How often does your board meet each year?

Please briefly explain, if you have chosen “Other”.

If yes, please provide details.

3.9 Provide a summary of your organisation’s financial controls, policies and

Click or tap here to enter text.

4.2 Enter Start Date for your project.

Enter End Date for your project. end date

4.3 Describe your project in 50 words or less

Click or tap here to enter text.

Number of People with Disabilities

Click or tap here to enter text.

Click or tap here to enter text.

Workshops, meetings, deliver Staff, money, time,

Click or tap here to enter text.

Click or tap here to enter text.

Click or tap here to enter text.

Click or tap here to enter text.

4.14 Explain the potential of your project to be sustained, replicated or expanded in

Click or tap here to enter text.

Click or tap here to enter text.

Outline your board/committee’s oversight and management arrangements for the

5.2 Complete the budget tables.

 Read the application guidelines in advance of completing the budget tables.

Equipment Costs for Staff

Direct Programme Costs

Assistive Technology or Equipment Costs

2021 2022 Explanation

Total Cost Grant Requested Own Funds

Click or tap here to enter text.

Terms and Conditions

4. By submitting this application the Board of Directors/Management Board acknowledges

Disclosure under the Freedom of Information

General Data Protection Regulations (GDPR)

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