APPLICATION FORM

 

 

 

FOR

 

 

 

COMMUNITY BASED/ NON-PROFIT ORGANISATIONS

 

PRINTING PROJECTS

 

 

Guidelines:

 

1.       This is the ONLINE application form to fill in if you are registered as a Section 21 compnay, NPO, NGO, CBO or cooperative. If you are registered as a sole proprietorship; close corporation, or private company, then you need to complete the Small Commercial Media Application Form.

2.       Give as much detail as possible (do not leave any blank spaces). Incomplete applications will be returned to you for more information which will delay the approval process.

3.       Please complete the application form in English.

4.      After clicking on SUBMIT at bottom of this page, please ensure that certified copies of the required documents are submitted to our offices (No application will be assessed without the copies)

5.       This is an electronic copy of the completed application form.

6.       Submit all further required documents to:

 

Postal Address                                                Physical Address

MDDA                                                             31 Princess of Wales Terrace

P.O. BOX 42846                                               4th Floor, Parktown

FORDSBURG                                                    PARKTOWN

2093                                                    

Tel: + 27 11 643 1100

Fax: + 27 11 643 1129

Email: Info@mdda.org.za

 

"New Mdda offices are situated opposite the Sunnyside Park Hotel in Parktown, "

 

7.       In addition to the ONLINE application form, you also need to submit the following documentation. Please note that your application will not be processed until the MDDA has received all of this documentation.

         Any media entity (Caxton, Kagiso Media, SABC, Primedia, Johcom, ETV, Mnet, Independent Newspapers, Media 24 etc.) that funds the MDDA

         Any political party

         Government

For any queries/ assistance, please contact the MDDA on 011 726-3336

 

 

MDDA Community Media Print Application Form

***Please note that ALL Fields are NECESSARY***

THE APPLICANT

 NAME OF ORGANIZATION:

 

 PHYSICAL ADDRESS:
 

 POSTAL ADDRESS:
 

ORGANISATION'S CONTACT DETAILS:

Name & Position of contact person
Name of alternative contact person
Phone number (s) (include dialling code)
Mobile / Cell number(s)

Fax number
Physical Address



Postal Address



Email address
Website Address

YOUR BANKING DETAILS:

Name of Bank
Branch Name
Branch Code
Account Type
Account Number
Name(s) AND ID Number(s) Of Account Holder(s)
or Signatories




IS YOUR ORGANISATION REGISTERED? IF SO, WHAT IS ITS LEGAL STATUS?:


REGISTRATION NUMBER:


DESCRIPTION OF THE APPLICANT

Give us background about the project (Include information about when it started, how It started, who initiated it and why):


Give us a summary of the area in which the project will be implemented (Include Information about the other forms of media that exists in that area):

 

What are the goals and objectives of your project? (What are you trying to achieve with this project?):

 

What are your projects main activities? (current/ intended):

 

What is your projectís total cost?:

 

How much are you requesting from the MDDA?:

 

 

Please provide a detailed itemised breakdown of your budget

The following is an example of how to put together a budget. Please ensure that your budget is in this format which this level of detail. Please also ensure that you submitted three VAT inclusive quotations for any printing or equipment requests.  

EXAMPLE:

Line Item

Detail

Cost

Workshop costs

25 delegates@ R250.00 per person x four days

R 6,250.00

Facilitation costs

1 facilitator for 2 days preparation, 4 days of facilitation and 1 day of report-writing @ R 1,000.00 per day

R7, 000.00

Printing costs

16 page edition @ R20.00 per edition x 250 copies x 6 months

R 30,000.00

 

Total

 

R 43,250.00

What will the funds be used for?:

 

JUSTIFICATION

What community problems/ issues is your project trying to address?:

 

What other forms of media already exist in your targeted area? (newspapers, magazines, newsletters, television, radio):

 

How is your media project different from the ones already existing in your targeted area?:

 

Describe the target group that your project intends to reach and explain why you have chosen that group. (Include issues of gender, age group, disability, socio-economic status, literacy levels, HIV/AIDS etc.):

 

How has the target group and the target area been identified?:

 

How does your project contribute towards addressing the issues/ problems experienced within your community (Refer to issues on 3.1.):

 

How does your project promote the use of the local African languages? Culture?:

 

What impact would this project have on the targeted people and areas?:

 

How do you/ intend marketing your project to the intended target groups and areas?:

 

  OWNERSHIP

Is the community involved in the project? If yes, How:

 

What procedures/ systems are in place for the project to report and account to the community?:

 

Please provide information about members of your governing body on the table below:

FULL NAMES        POSITION HELD AT PROJECT     EXPERIENCE & SKILLS     GENDER     RACE

Wiseman Ndlela                   Chairman of Board                             Journalism Diploma, Engineer            Male            African

How were these people elected into their positions?:

 

SUSTAINABILITY

How many people are employed in this project? What skills do they have to ensure the successful implementation of the project?:

FULL NAMES         POSITION HELD AT PROJECT     EXPERIENCE & SKILLS     QUALIFICATIONS

What resources do you have? :

OFFICE:

 

OFFICE FURNITURE:

 

EQUIPMENT:

 

INTERNET AND EMAIL ACCESS:

 

Who are your partners? What contribution/ role do these partners play in assisting the project to realise its objectives?:

 

Is your organisation a member of any media networks or Associations in the country? If so, please list the partners?:

 

What other sources of funding does your organisation have?:

SOURCE OF FUNDING        YEAR FUNDED                AMOUNT  

 

 

 

 

 

 

How will your organisation ensure that the project continue to exist beyond the MDDA grant?: