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					                                              Adult and Community
                                                  Learning Service
                                          Application for Share/Family
                                        Learning Programmes Funding
                                               August 2011-July 2012

          Please read the guidance notes and all the questions accompanying this
           application before you complete this form.

      Your application will not be considered unless a Scheme of Work (see Q10) & a Tutor
       Personal Information Record (see Q14) are attached

If you have any difficulty in completing this application, please contact one of our Community
Learning Officers or the Family Learning Development Worker as detailed on page 2 of the
Guidance Notes, who will be pleased to assist.

Applicant details:

Name of organisation:

Name of person submitting

Role of person submitting

(If the applicant is not based within
the delivery venue.) Named
contact within school/Children’s

Course title(s):

Planned start / end dates:

For office use only          Date received:
   ACLS 13/09/11 Version 4
                          Section One – About Your Organisation

1.     Address of organisation:

Postcode:                                               Telephone:

Is your organisation a:
Community Organisation                                  Voluntary Organisation
Local Authority                                         Children’s Centre
Other (please specify)                                  School
VAT registered?                                         VAT no:

2.   Name and contact details of the person ACLS should contact in the event of a query
     with this application:
Name:                                           Job Title:
Telephone:                                      Fax:
Mobile:                                         Email:

3.     Have you applied for ACLS funding before?

Yes                            No                       Which academic year:

Please list previous contract numbers:


4.     Does your organisation have?                                  Yes             No   Developing

A written equal opportunities statement
A health & safety policy (please see guidance notes)

Public liability insurance to a minimum of £5,000,000

At least 2 years of audited accounts

For community/voluntary organisations only                           Yes             No   Developing

Does your organisation have a management committee?

Do you have a written constitution?

     ACLS 13/09/11 Version 4
                               Section Two – About the Course

5.     Course details:
Start                                               End
date:                                               date:
Joint Adult and Child:                             Adult only.

 Course location & address:

Telephone:                                           Postcode:
Total sessions            x    Hours per session                 =      Total course hours
Will the course lead to a qualification?                               Yes           No
If yes please give details

How many Adult learners do you anticipate will be involved in the course?
How many Child learners do you anticipate will be involved in the course?

6.     Please give the name(s) of tutor(s) delivering the course & enclose a completed
       Tutor Personal Information Record

7.     Teaching Information                                                   Yes            No

Is your organisation aware of the new requirements for tutor
qualifications/CPD and Institute for Learning registration (IFL)?
Guidance is available from ACLS.

Details required for all staff teaching Share/Family Learning
programmes:                                                                   Yes            No

a) Is the tutor(s) registered with the Institute for Learning (IFL)
b) Has the tutor(s) been checked through the CRB? (Within the last 3
c) If not CRB checked please state when this is scheduled

     ACLS 13/09/11 Version 4
8. If the tutor that you intend to use is not part of your own organisation, please provide
   the name & address of the organisation providing the tutor:


9.     It is important to ACLS that our learners have access to          Your
       impartial information, advice and guidance (IAG) about other   organisation
       courses or opportunities they may wish to take up. Who
       would you prefer to provide this?


  10. ACLS has a duty to advance equality and diversity - please describe in some detail
  how you will support this in your
  a) course content
  b) teaching and learning e.g. induction /lesson planning/ learner support/group profiles
  c) promotional activity

     ACLS 13/09/11 Version 4
11. Have you ensured that the building/room you plan to use                  Yes     No
complies with the Disability Discrimination Act (DDA) and Special
    Educational Needs & Disability Act (SENDA) Legislation?

12. Is it accessible to people with disabilities and are you able to offer   Yes     No
    any necessary support?

13. Do you own, lease or rent this venue?                          Own       Lease   Rent

14.* Have you undertaken a recent Health and Safety Assessment for           Yes     No
     the venue?

15. Have you undertaken a recent Risk Assessment for the activity?           Yes     No

      * Health & Safety Assessments need to be undertaken by a competent person,
                            please refer to the guidance notes

                                     Section Three
                     16. How was the need for this course identified?
  ACLS 13/09/11 Version 4
17. How much will the course cost?

ITEM                                    Hourly Number of      Total
                                     rate/units hours/units      £

Management Costs
Tutor Costs
(including Ni and Sup
where applicable)
Course development
Admin Costs
Materials for
delivery (Please include
itemised list with costs)

Sub total

Number of GLH per course
(contact time)
Childcare Costs
Venue Hire
Additional Learner
Exam costs ( where
Other : Please

Other match funding available to
support delivery costs e.g.
contributions in kind if room hire
not being charged, what would
the cost have been?

Number of courses
ACLS 13/09/11 Version 4
  ACLS use:

18. Costs per learning hour & per learner

The total cost              ÷                  =
of the course
(inc. match                     Number of          Cost per
funding)                        hours              learning hour

The total cost              ÷   Number of      =
of the course                   learners
(inc. match                     (i.e. adults       Cost per
funding)                        only)              Learner

  ACLS 13/09/11 Version 4
19. Agreement
The following section must be completed by the main person who is responsible for this
funding application on a day to day basis.
If this application is successful the organisation will agree to the following items:
1. If successful we will enter into a funding agreement with ACLS detailing the terms and
   conditions of the funding.
2. We will comply with any relevant legislation affecting the way that we deliver the course.
3. ACLS can use our name and the name of the course in its own publicity.
4. We will ensure that the following documents are completed and supplied to ACLS:
    Learner Enrolment Forms (ACLS Form 06) for all eligible students as appropriate
    Share/Family Learning diaries will be completed for all students on the course
    Completed Registers of Attendance for all students on the course (ACLS Form 04)
    Completed Learner Evaluation Forms at the end of the course (ACLS Form 02)
    Completed Tutor End of Course Report / Evaluation Form (ACLS Form 16)
    Course Data Sheet - (ACLS Form 01)
    Valid invoices for expenditure & claim forms for time spent
5. We will acknowledge the funding in any publicity materials we produce, in our annual report,
   our Chair or Secretary’s report to the AGM and the accounts which cover the period of
   funding. We will supply copies of these to ACLS if requested.
6. If we receive funding for a course, we understand that ACLS will not automatically fund any
   later course.
7. We will keep all financial records and accounts, including receipts for items purchased with the
   funding, for 6 years after the date of receipt of the final payment. We will make these available
   to ACLS, Nottinghamshire County Council internal and external audit and the Learning & Skills
   Council. We understand that this does not release us from our legal responsibility to keep
   records for longer periods.
8. ACLS may hold back or ask us to repay the funding, in whole or in part, in the following
    If we fail to keep the contract in any way
    If we fail to keep and supply all records as stated in 4 above
    If we do not comply with the terms and conditions of the contract
    If the application form was completed dishonestly or the course documents give false or
       misleading information
    If we do not follow equal opportunities practice in employing people, recruiting new
       members and providing our services
    If any member of the organisation, staff or volunteers, acts dishonestly in their work for us
       at any time during the course
    If we fail to complete the course by the date in the contract
    If we close down, become insolvent or bankrupt

I confirm that the group named in section 1, question 1, has authorised me to sign this agreement
on their behalf. The information given in this application is correct and I agreed to abide by the
terms and conditions of this agreement and the subsequent funding agreement.

Signature:                                               Job Title:

Print name:                                              Date:

   ACLS 13/09/11 Version 4
   ACLS can only process your application if:
      You have completed all the questions on this form
      You have completed the section on finance of the course
      A person authorised to apply on behalf of the organisation has
       signed the form
      You enclose all necessary documents

   Please use this checklist to make sure you are sending us everything that we need
                                to assess your application.
We have answered all the questions on the form
We have made a copy of this application for our own reference
We have completed and attached the Generic Location Health & Safety Assessment
We have completed the finance section
We have enclosed a copy of the course outline/scheme of work
We have enclosed the Tutor Personal Information Record of the tutor/s who will be
delivering the course including CRB number/date.
We have enclosed a copy of our:
Written constitution (voluntary organisations)
Safeguarding policy
Equality of Opportunity Statement
Health and Safety Policy
Public Liability Insurance Certificate
We have completed an Activity Risk Assessment (Where appropriate)

  Please return your signed, completed application and supporting documentation to:

           Adult & Community Learning Service
           Communities Department
           Nottinghamshire County Council
           3rd Floor
           County Hall
           West Bridgford
           NG2 7QP
  Email:    FAX no: 0115 9773859
  Please submit your application in plenty of time before the
  proposed start date to allow for processing and any queries to be
  addressed. If you require additional help completing this form,
  please contact us.

  ACLS 13/09/11 Version 4

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