Art and Culture Grant Application form

GRANT APPLICATION FORM
FOMO YA IKOPELO MADI A DITHUSO

GRANT APPLICATION FORM
All applications should be made on this form. Make three copies of the whole application.
Keep one copy and send two to the following address: Department of Culture and Youth,
P/Bag 00185, Gaborone Fax: 3909227. E-mail: Cultureandyouth@gov.bw.
If you need help with the completion of this form, Contact Culture Officer (Projects) on the
above number or contact your nearest Culture and Youth Office.
Dikopo tsotlhe di tshwanetse go kwalelwa mo fomong e. Dira meriti e le meraro ya
dipampiri tsa ikopelo. Sala ka e le nngwe mme o romele tse di setseng kwa
atereseng e: Department of Culture and Youth, P/Bag 00185, Gaborone Fax:
3909227. E-mail: Cultureandyouth@gov.bw.
Fa o na le bothata jwa go tlatsa fomo e, kopa thuso mo go ba ofisi ya Tsa Ngwao le
Banana kana mo babereking ba puso ba ba kwa metsaneng e e gaufi le wena.
1. (a) Short term- project/ Tirokgolo ya nakwana
(b) Long term- Annual programme/ Tirokgolo ya nako e telele/ Tiro ya
ngwaga le ngwaga
PROJECT CATEGORY/ TIROKGOLO E WELA HA KAE
Music- Choral / Diletso le dikopelo
Poetry & Literature/ Poko le tlhamo
Performing arts Workshops & Festivals/ Dithutiso tsa metshameko
tshwantshiso le meletlo kakaretso
Dance /Mmino
Visual Arts & Crafts/ Botaki le tiro tsa diatla
Theatre & Musical Theatre /Metshameko Kitsiso le metshameko Kopelo
Others/ Tse dingwe _______________________________________________________
2. How much are you requesting/ O kopa bokae?
3. Purpose for grant/ O tsile go dirisa madi mo go eng?
__________________________________________________________________
4. HISTORY AND PROFILE OF ORGANISATION/ DITSO LE SEEMO SA
MOKGATLHO
a) What is the name of your organisation?/ Leina la mokgatlho wa gago ke mang?
_________________________________________________________________
b) When did it start operating? /Mokgatlho wa gago o simolotse leng go dira?
__________________________________________________________________
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c) Where is it currently operating? /Mo bo gompienong le direla fa kae?
__________________________________________________________________
d) What does it do? (Be brief) / Mokgatlho wa lona o itebagantse le eng?
__________________________________________________________________
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e) What are the organisation’s aims and objectives? / Maikemisetso le maikaelelo a
mokgatlho wa gago ke eng?
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f) List Organisation’s achievements:/ Rulaganya tse mokgatlho wa lona o setseng o
kgonne go di dira:
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5. APPLICANTS PARTICULARS/ TSE DI AMANG BOLENG JWA MOIKOPEDI
a) Applicants Name: / Leina la moikopedi: _______________________________
b) Position of Applicant in the organisation (i.e. Secretary or Treasurer): Maemo a
moikopedi mo mokgatlhong (ke gore mokwaledi kana motshwara madi)
________________________________________________________________________
c) Applicant’s address: / Letlole la poso la moikopedi:
__________________________________________________________________
__________________________________________________________________
d) Give full names and addresses of Director/ Coordinator/ Chairperson and
Secretary of Organisation: Fa maina a a feletseng le di aterese tsa mookamedi/
molomaganyi/ modulasetilo le mokwaledi wa mokgatlho:
i._______________ ii. ________________ iii._________________ iv.________________
_______________ ________________ _________________ ________________
_______________ ________________ _________________ ________________
_______________ ________________ _________________ ________________
e) Applicants/ Organisation’s contact numbers/Dinomore tsa moikopedi kana tsa
mokgatlho:
Office /Wa ofisi _______________
Fax /Fekese __________________
Home/ Wa kwa gae ___________________
E-mail /Mokwalo wa boranyane _________
6. The Organization’s Bank Account Details/ Tsa Letlole La Polokelo (Banka)
Ka Botlalo:
a) Bank Name/ Leina la kwa o bolokang madi teng: ___________________________
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Account Number/ Nomore ya Letlole: _____________________________________
b) Name of Account holder /Leina la motlhokomedi wa Letlole:
___________________________________________
7. PROJECT DESCRIPTION / TLHALOSO YA TIROKGOLO YA MAIKAELELO
a) Full Project description- what the organisation intends to do and how it plans to carry
out the project/ Tlhaloso e e tletseng ya tirokgolo- Se mokgatlho wa lona o
ikaelelang go se dira le ka fa o ikaelelang go tsamaisa tirokgolo e.
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b) What are the aims of the project? / Maikemisetso le maikaelelo a tirokgolo ke eng?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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c) Who will benefit other than yourselves from the project? /Kwa ntle ga mokgatlho, a
gona le bangwe gape ba ba tla a solegelwang molemo ke tirokgolo e?
_______________________________________________________________________
_______________________________________________________________________
8. Where will the project take place? / Tirokgolo e ya go direlwa kae?
_______________________________________________________________________
9. When will project begin and when will it complete? / Tirokgolo e tla simolola
leng ebile e tla fela leng?
_______________________________________________________________________
10. Have you received any grants from the DCY in the past? /A o kile wa fiwa madi go
tswa mo lephateng le? ____________________________________________________
If the answer is Yes, give details of funds received in excess of P5 000.00 in the last
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three years: Fa o kile wa fiwa madi, fa tshedimoso ya madi a okileng wa a fiwa
go simolola ka P5 000.00 mo ngwageng tse tharo tse di fetileng.
GRANT
RECEIVED
FROM/ MADI A
AMOGETSWE
GO TSWA MO
GO
AMOUNT/
SELEKANYO
SA ONE
DATE/
LETSATSI
EXPENDITURE
REPORT SUBMITTED
YES / NO/ PEGO
YA TIRISO YA
MADI E SETSE E
ISITSWE
EE/NNYAA
REPORT
INCLUDED
WITH THIS FORM
YES / NO/ PEGO
E TLA LE FOMO
E, EE/NNYAA
IF YOU HAVE NOT SENT IN A REPORT ON THE USE OF A PREVIOUS GRANT,
YOUR APPLICATION WILL NOT BE PROCESSED/ FA O NE O ISE O ROMELE
PEGO YA GORE O DIRISITSE MADI JANG, KOPO YA GAGO GAE NA GO
SEKASEKWA
11. OTHER FUNDING /MADI A MANGWE GO TSWA GO SELE:
Have you applied for funding or support in kind for this project from Government or from
anyone else? Please indicate if this is just applied for, or if you have already received it/ A o
kopile madi kana thuso nngwe fela mo pusong kana gongwe go sele? Tswee - tswee
tlhalosa gore a ke gone o dirang kopo kana o setse o filwe madi a go nna jalo.
_____________________________________________________________________________
_____________________________________________________________________________
12. PLEASE GIVE A BREAKDOWN OF ALL EXPECTED INCOME AND EXPENDITURE RELATING
TO THE PROJECT/ KA TSWEE- TSWEE SUPA KA FA TIROKGOLO E TLILENG GO DIRA
MADI KA TENG LE GORE A TLILE GO DIRISIWA KA MOKGWA O FE :
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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If you have difficulty in completing any part of the form, seek advice locally e.g.
The Culture and Youth Office, The Village Extension Teams, before you submit your
application/ Fa o na le bothata jwa go tlatsa fomo e, kopa thuso mo go ba ofisi ya Tsa
Ngwao le Banana kana mo babereking ba puso ba ba kwa metsaneng e e gaufi le
wena.
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13. ATTACHMENTS /DIMAMETLELWA TSE DI TSHWANETSENG GO ROMELWA:
Applicants should include the following attachments/ Baikopedi ba tshwanetse go
romela tse di latelang:
a) Break down of all Income and Expenditure/ Tlhaloso ya dikatso le tiriso ya madi.
b) Include the following certified copies: Omang, Registration Certificate and Constitution/
equivalent/ Romela tse di latelang mme di tlhomamisitswe: Omang, setlankana le
molao- motheo wa mokgatlho kana seNgwe sa go nna jalo.
c) Enclose background of organisation/ detailed proposal if available/ Romela tlhaloso
ka ga tshimologo ya mokgatlho le mokwalo wa maikaelelo a tirokgolo fa dile
teng.
d) Attach Reference letters, pictures or any information that can act as reference/ Romela
makwalo a a supang bokgoni jwa mokgatlho go tswa kwa go ba ba o itseng,
ditshwantsho kana sengwe le sengwe se se ka lo supelang ka botlalo.
e) Attach C.V./ Tsenya togamaano ga mmogo le mokwalo o o supang bokgoni jwa
mokopi wa madi.
f) Enclose a report of your most recent bank account statements/ Romela pego ya
poloko ya madi a mokgatlho wa lona e e ntshitsweng bosheng (mo kgweding tse
thataro 5
e) Five quotations from different suppliers or shops where applicable/ Ditlhwatlhwa tse
tlhano go tswa mo bagwebing kana barekisa dithoto ba ba farologanyeng
Applicant’s Signature/ Sekano sa moikopedi: __________________________
Date/ Letsatsi: __________________________
WITNESS - officer receiving the application/ Mosupi- Modiri yo o amogelang kopo
NAME/ Leina __________________DESIGNATION /Maemo ____________________
SIGNED/ Monwana wa maikano ______________
DATE /Letsatsi ___________
Please return the completed form and any attachments to/ Tswee tswee busetsa
fomo e e tladitsweng ka botlalo ga mmogo le dimametlelelwa dife fela go:
The Director
Department of Culture and Youth
P/Bag 00185, Gaborone
Tel: 3909222 Fax: 3909227 e-mail: Cultureandyouth@gov.bw OR use your nearest
Culture and Youth Office to Bridge Proposal to GAC
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14. CHECKLIST/ ELA TLHOKO GORE:
Have you included the following? A o rometse tse di latelang?
Tick/ Tshwaa
1. A full description of your project/Tlhaloso e e tletseng ya tirokgolo
2. A Constitution or equivalent (if not previously supplied)/ Molao- motheo wa
mokgatlho kgotsa sengwe sa go nna jalo
3. Your most recent bank account statements/
Sesupo sa tiriso ya madi mo letloleng sa mo bosheng
4. Any C.V.’s of artists or other necessary attachments / Bosupi jwa bokgoni jwa
batlhami kana tse di ka tswang di tlhokega go tsenngwa
5. Have you submitted a report on grants previously received?/ A o tsentse pego ya
madi a o kileng wa a fiwa mo nakong e e fetileng
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PLEASE FILL IN THE RETURN SLIP/ TSWEE TSWEE TLATSA SEKGETHE SA
PAMPIRI MME O SE ROMELE
Applicant/ Moikopedi
Name/ Leina
___________________________
Address/ Aterese ___________________________
___________________________
___________________________
For Official Use Only/ Fa go tlatsa badiredi fela
This is to acknowledge receipt of your application received on /Se ke sesupo sa kamogelo ya
kopo ya gago e e amogetsweng ka: ______________________
Your reference number is/ Nomore- seka- bosupi ya gago ke ______________________
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