NCSS Template - Normal s1

Request for MSF Support for Direct Grant of Tenancy to Relocate / Expand at HDB Void Deck or State Properties

Instructions: 1) Please complete all sections of this application form and submit it together with the relevant attachments for supporting documents to:

Email: [email protected]

Address: Premises Support Request Application Facilities Branch Service Support & Resource Division Ministry of Social and Family Development 510 Thomson Road #16-02 Singapore 298135

2) Incomplete or illegible applications will not be considered.

3) IMPORTANT NOTE:

 MSF supports direct grant of tenancy of State Property / HDB void deck for VWOs to operate direct social services1. For all other services not under MSF’s purview, please approach the relevant supervisory authority / Ministry to request for support.

 The prerequisite of this application is VWOs should have either Charity or IPC status. The social services provided must not bear any racial, religious or sectarian connotation.

 Stay-in/residential facilities, facilities for headquarters or office administrative purposes are not eligible for HDB void deck premises.

 MSF’s support is subject to regular reviews every three (3) years on continued relevance of the proposed social services and programmes.

 MSF’s support for direct grant of tenancy does not extend to (a) capital funding for renovations, upgrading, maintenance etc. of the allocated premises; and (b) rental subvention or funding for other tenancy related costs such as security deposit, fire insurance policy, processing fee or stamp duty, etc. in part or whole.

1 Should be providing direct services, which are social service-related and contribute to the psychological and social well-being of the target clients (excludes health, direct financial aid, legal, sports, recreation and education).

of 7 Section A: Particulars of Voluntary Welfare Organisation

Name of organisation:

Current address:

Website Address:

Email:

Telephone/ Fax:

Section B: Contact information of the Person In Charge of Application

Full name:

Title/Designation:

Email:

Contact number (mobile/ office/ fax):

Section C: Legal Status of Voluntary Welfare Organisation

Please check () the relevant box (if applicable)

Registered under Registry of Societies/ Accounting and Corporate Regulatory Authority/ Established under Written Law.

Registration number: ______

Registered with Commissioner of Charities as charity

Charity registration number: ______

Acquired Institution of Public Character (IPC) Status

IPC registration number: ______

Note: Please provide photocopy of all the relevant registration.

of 7 Section D: Purpose for new premises

Please check () at the appropriate box

Purpose for new premises

Expansion – keeping current premises but adding additional floor area (adjoining/separate)

Relocation – moving out of current premises and shifting into new premises

Please provide reasons for requiring expansion/ relocation.

Section E: Details of programmes

Description of the programme(s)

Please provide detailed information on the following:

1. Provide information on the description, clientele, frequency and desired outcomes of the programmes to be operated in the expanded/relocated premises.

Name of Description Target Clientele and Age No. of Regularity Desired outcomes programme needs

E.g. Programme to engage Youths who are Daily, Youths have Befriending,youths and to be a friend exhibiting signs of 50-60 50 Weekly, improved relationship counselling by lending a listening ear. being at-risk , seniors, yr old Monthly with significant people with special others. needs

of 7 2. Please indicate the areas that the programmes will serve. E.g. Bishan, Ang Mo Kio constituency, North East Community Development Council Boundary, the whole of Singapore etc.

3. How will the programmes meet the service needs and address the service gaps in the community?

4. List the sources of funding for the programmes and the expansion/relocation of the premises.

5. Please highlight if there are similar social services or programmes serving the same profile of clients in the vicinity of the requested premises (e.g. 2km of the proposed location). If there are, how does your programme value-add to create a greater synergy?

6. What is the staff strength at the current and expanded/relocated premises?

7. Please state plans for partnerships with other Organisation(s) E.g. Referral by schools, NCSS, collaborations with other VWOs.

8. Please provide the past 6 month schedule of each activity/programme held at the current premises, including number of participants, regularity and rooms/facility /venue held for existing services.

of 7 Section F: Details of requested premises

1. Exact address of requested premises:

2. Estimated floor area (in m2) of requested premises:

3. Estimated floor area (in m2) of current premises:

4. Please provide the following information and attach more details:  Supporting documents from HDB / SLA on availability of void deck / properties.  Proposed space breakdown and utilisation in requested premises.  Proposed space breakdown of current premises and attached lay-out plan or rough sketch showing floor area usage (if available).

Space breakdown and utilisation in requested expanded/relocated premises

Type of room(s) Floor area (m2) Quantity Purpose Frequency Capacity per room required of room(s) (for programme, activity, admin, etc)

2 [For example:] 2m 2 For counselling of clients 3 times / Daily, Weekly, Counselling room week Monthly

Admin office 5m2 1 For office admin Daily 8 pax per room

Pantry, Toilet 1m2 1 Basic office amenities Daily N.A.

Total: About ___ m2

of 7 Space breakdown of current premises

Type of room(s) Floor area (m2) Quantity Purpose Frequency Capacity required of room(s) (for programme, activity, admin, etc)

2 [For example:] 2m 2 For counselling of clients 3 times / Daily, Weekly, Counselling room week Monthly

Admin office 5m2 1 For office admin Daily 8 pax per room

Pantry, Toilet 1m2 1 Basic office amenities Daily N.A.

Total: About ___ m2

Section G: Support from grassroots and any other organisations

Please provide comments from the grassroots, e.g. Citizen’s Consultative Committees (CCCs), Residents’ Committees (RCs), on whether the proposed services meet the local community needs. Please also attach any support from the grassroots and other organisations.

of 7 Section H: Declarations

We declare that: i) our organisation is free from any litigation; ii) all the facts stated in this application and the accompanying information are true and correct to the best of our knowledge and that we have not withheld/ distorted any material facts. We understand that if we obtain MSF support by false/ misleading statements/partial disclosure not in line with the support intent, MSF reserves the right to immediately withdraw the support; and iii) we understand that MSF reserves the right to reject our application, and that the reason(s) for which the application is rejected need not be disclosed.

SIGNATURE OF CHIEF EXECUTIVE SIGNATURE OF CENTRE/ ORGANISATION STAMP OFFICER/ EXECUTIVE DIRECTOR/ PROGRAMME MANAGER BOARD CHAIRMAN

NAME (IN BLOCK LETTERS) NAME (IN BLOCK LETTERS) DATE