<p> TETA FUNDING APPLICATION FORM YEAR 2016/17 Funding Window DATE RECEIVED REFRENCE NUMBER DATE PROCESSED</p><p>Chamber:</p><p>Project: SECTION A: APPLICANT DETAILS</p><p>NB: SUBMIT ONE FORM FOR EACH APPLICATION</p><p>Name of Applicant/ Organisation</p><p>Non- Levy Payer</p><p>Applicant’s Category Levy Payer</p><p>Skills Development Levy Number (if levy L payer) More Less than 2-5 6-10 Period Of Company Existence than 10 1 year years years years Company Registration Number (Cipro No.) Vat Registration Number Name Designation Telephone Number Applicant/Organisation Contact Person Mobile Number Fax Number Email Address Applicant/Organisation Contact Person (2) Name </p><p>CONTROLLED DOCUMENT -DO NOT MAKE UNAUTHORISED COPIES- 1 of 10 Designation Telephone Number Mobile Number Fax Number Email Address</p><p>Physical Address Of Applicant Municipality Province Code</p><p>Postal Address Of Applicant (if not the same as above) Municipality Province Code</p><p>S T g C E n i J</p><p> r g O a d n t i R</p><p> e a l l h e P o e d g C c i C</p><p>Name of Chamber (Please R n I a m i r e l i a & i r x G p e t a i H F s</p><p> tick most applicable to a E g g</p><p> r R o t T T n n d a i r h e A your line of a e d s g M R r o i s A T a e R business/training a r S P w F E r</p><p> requirements) C o I F F F O</p><p>FOR OFFICE USE ONLY </p><p>Date received: ______/______/ 2015 Received by:______</p><p>Signature of Recipient: ______</p><p>STAMP</p><p>Page 2 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES- SECTION B: PIVOTAL PROGRAMME IMPLEMENTATION PLAN</p><p>SMALL MEDIUM LARGE BEE SIZE / TYPE OF (0-49) (50-150) (151+) COMPANY PRIVATE HET TVET OTHER PROVIDER MARK WITH AN X Co- CBO NGO/NPO NLPE operative</p><p>List current DG Programmes</p><p>Pivotal Programme Complete a single cell, identifying project/ grant name and delivery approach. Type WORK SKILLS INTERGRATE BURSAR INTERNSHI LEARNERSHIP APPRENTICESHIP PROGRAMM AET D LEARNING Y( EMPL RPL P E (TVET & OYED) UNIVERSITY)</p><p>Programme Name Target Province (s) ALL EC FS GP KZN LIMP MPU NC NW WC Is this a second or third year support to already funded TETA project? Roll over E.g.: 2nd Year Cadet OR Apprentice YES NO EMPLOYED UNEMPLOYED Insert number Insert number W W AM AF IM IF CM CF WF D AM AF IM IF CM CF WF D M M</p><p>Page 3 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES- Designated Groups and Equity Principles</p><p>Percentage of learners whom are disabled</p><p>Explain if any learners will be placed or employed </p><p>Explain benefit to rural learners</p><p>Strategic Goal: TETA SSP /TETA APP/ CHAMBER SKILLS Indicate TETA SSP / Scarce / critical skills</p><p>Expected Impact within industry sector: Describe how target group and Industry will benefit</p><p>Strategic Partners: Co-operation with other organisations</p><p>Service Provider (s) involved: Provider 1 Provider 2 Name/s of training providers, accreditation number and date of expiry Attach proof of accreditation for programme applied for Private / Public Provider: Accredited SETA: Accreditation Number:</p><p>Page 4 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES- PROPOSED START DATE: PROPOSED FINISH DATE: DURATION (MONTHS) Period of Activity of Total (MM +YYYY) (MM +YYYY) (MM +YYYY) Program / Project e.g. L/Ship = 12 Months</p><p>Break down of cost (allowance only applicable to unemployed learners on the below types) TYPE Number of learners TOTAL COST Learnership R Skills Programme R Apprenticeship R RPL R Bursary R Internship (12 months) R Work Integrated Learning (TVET & University Graduates) R ABET R Total – Training Cost R Total – Allowance Cost R TOTAL COST R Total Program / Project Costs Applied For R REFER TO TETA FUNDING MODEL</p><p>SECTION C: PIVOTAL PROGRAMME SUMMARY d</p><p> e f d</p><p> y f e o</p><p> o y o . l</p><p>. o o p l o N p m s Type of N r e s Programme / Project Title and registration number NQF Level m t e n E Programme: i n d U r e a r e C L</p><p> </p><p>Total Funding Applied for (incl. of VAT): R______</p><p>NAME OF ORGANISATION’S / APPLICANT’S EXECUTIVE:</p><p>Page 5 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES- POSITION OF THE ORGANISATION’S EXECUTIVE: SIGNATURE OF THE ORGANISATION’S EXECUTIVE: SIGNATURE OF TRAINING COMMITTEE CHAIRPERSON: (WHERE RELEVANT. IN CASE WHERE THE ORGANISATION HAS MORE THAN 50 EMPLOYEES) DATE OF SUMISSION:</p><p>SECTION D:PROJECT/GRANT PLAN</p><p>BACKGROUND:</p><p>PURPOSE:</p><p>PROJECT OBJECTIVES:</p><p>Page 6 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES- BENEFITS TO TETA:</p><p>BENEFITS TO THE TRANSPORT SECTOR:</p><p>BENEFITS TO THE APPLICANT ORGANISATION:</p><p>BENEFITS TO THE RECEPIENTS:</p><p>Page 7 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES- SECTION E: ATTACHMENTS</p><p>1. Provider proof of accreditation for project 2. Applicant company BEE score card 3. Applicant company registration documents ( this applies to applicant’s/ organisations whose documents are not captured on the SMS system) 4. Project Implementation Plan</p><p>SECTION E: PREVIOUS PROJECT HISTORY</p><p>1. Current projects? 2. Status of Current Projects 3. Have you ever had a DG project cancelled? If Yes, please provide reasons and documentary evidence if applicable.</p><p>FOR OFFICE USE ONLY </p><p>Date Confirmed: ______/______/ 2015 EO:______</p><p>Signature of EO: ______</p><p>SECTION F: SELF ASSESSMENT CHECKLIST</p><p>Page 8 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES- CHECKLIST BEFORE SENDING YOUR APPLICATION YES NO</p><p>Does the application meet the Discretionary Grant criteria? Is the project applied for in the requested list of PIVOTAL Programmes? Are my total budget allocations per project in line with the approved TETA funding model? Have I completed all required sections of the application form (Section A – Administration and Section B – Implementation and Section C- PIVOTAL Programme Summary) Has a provider/s been verified with the applicable ETQA in respect of their accreditation status? Are the proposed education and training providers accredited to provide the service they have been earmarked for? Have all relevant organisation parties been consulted and made aware of this application? Have all relevant organisational parties endorsed this application? Has the applicable company representative signed-off the application form? Is the application a product of consultation with stakeholder parties? As part of support, have I identified the relevant company support structures such as mentors for learners on Learnerships and Apprenticeships? Does the application address TETA scarce and Critical Skills / identified sector needs Are there any unspent funds against completed projects from the previous financial year? If yes above, have this been communicated to TETA in respect of committed funds or surpluses? Have I completed the application form adequately and requested assistance from TETA where in need of further clarity? Will my application reach the TETA Offices in time to meet the submission deadline?</p><p>TETA 2015 FUNDING WINDOW: SUBMISSION DEADLINE 31 JULY 2015 @ 16H30 As per TETA Discretionary Grant policy: “TETA will ONLY notify approved applicants of the outcome of the application within 90 days of the closing date of the grant window”</p><p>Applications can be delivered OR posted to the following addresses: Kwazulu Natal: 2nd Floor, 67 KE Masinga Road, Durban, 4001 Western Cape: WBHO House, Glen Roy Road, Pinelands, 7430</p><p>Page 9 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES- Randburg: 2nd Floor Sonsono Buildings, 344 Pretoria Avenue, Randburg</p><p>No emailed applications will be accepted.</p><p>Page 10 of 10 CONTROLLED DOCUMENT</p><p>-DO NOT MAKE UNAUTHORISED COPIES-</p>