Training Providers Profile Form Apr 2015

VWOs-CHARITIES CAPABILITY FUND (VCF) Training Provider Profile Form

Note: All fields need to be completed. Incomplete application forms will not be accepted.

1. INFORMATION ON TRAINING PROVIDER Training Provider

UEN No

Registered Address

Telephone

Name of Head of Organisation

Designation of Head of Organisation Email of Head of Organisation

Name of Contact Person (this refers to the person who submits the application and with whom VCF Secretariat will liaise regarding the details of the application) Designation of Contact Person

Telephone Number of Contact Person Email of Contact Person

Name of Staff submitting VCF claim Designation of Staff submitting VCF claim Telephone Number of Staff submitting VCF claim Email of Staff submitting VCF claim No. of years in operation

Objective(s) of organisation Key clientele

2. DECLARATION BY TRAINING PROVIDER

(1) We declare that the information stated in this application are true and correct to the best of our knowledge and that we have not withheld / distorted any material facts.

(2) We understand that if we obtain the grant by false or misleading statements, NCSS may, at its discretion, withdraw the pre-approval of the courses and recover immediately from us any amount of the grant that may have been disbursed for the pre-approved courses.

(3) We accept that the decision made by the VCF Evaluation Panel is final.

(4) We understand that the pre-approval of courses is granted based on the information provided in this application. Any changes to the course information (e.g. change of course title, course fee, trainer(s), course content, class size etc) within the pre-approval period will need to be submitted to VCF Secretariat in writing, at least 1 month before the first run of the course, for the Evaluation Panel’s decision on pre-approval. Pre-approval status may be suspended pending the outcome of the revision.

(5) We declare that we are currently free from litigation.

______Signature & Company Stamp Date

______Name Designation (Head of Organisation)

This form is to be mailed to:

Ms Eileen Lim Fund Allocation Team National Council of Social Service 170 Ghim Moh Road, #01-02 Singapore 279621