Creative Places Tuam Taking Root Community Fund Taking Root Fund Step 1 of 3 33% Creative Places Tuam Taking Root Community Fund Please ensure that you have all the information that you will need to fully complete this form to hand, including all supporting material. You can save your application part-way through and access it again within 30 days, but remember that you must submit in full in advance of the deadline. The open call/ guidelines document contains clear instructions on the information you will need, in order to complete the form. If you have technical issues using the form, contact info[at]create-ireland.ie with your query. Deadline: 5pm, Thursday 9th February 2022 1.1 Please provide Name of Community/ Group (if applicable)* Name of applicant or person applying on behalf of the group* Pronoun(s) Position in group (if applicable) Address* Town County Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone numberEmail address* Enter Email Confirm Email Website Social media 1.2 About you/ your group Please indicate which social context is relevant to your application* Access, Inclusion and Disability Health and Wellbeing Older People Socially Engaged Arts Children and Younger People Cultural Diversity Community Development Heritage and Local History Environment Law and Social Enterprise Justice and Probation 1.3 Please describe the nature of you/ your group or organisation and work (300 characters)*e.g. are you a volunteer or volunteer-led group, charity, local artist, local business etc 1.4 Equality, Diversity and Inclusion In line with Create's commitment to Equality, Diversity and Inclusion, we have included some questions below which help us to understand more about the individuals we are engaging with. If you are applying on behalf of a group, please answer these questions from a personal perspective. This information has no bearing on your application's assessment, and is purely for internal reporting and analysis Data collected will only be used in an aggregated, anonymised fashion. In live with GDPR regulations, your information will not be shared with any third parties.Gender* Female Male Non-Binary Prefer not to say Ethnicity* Black or Black Irish - African Black or Black Irish - any other Black background Asian or Asian Irish - Chinese Asian or Asian Irish - any other Asian background White Irish Any other White background Irish traveller Mixed ethnic group (please state in box below) Any other ethnic group (please state in box below) Prefer not to say Language*What is your first language? Disability*Do you consider yourself to have a disability? Yes No Prefer not to say 1.5 Please indicate if Creative Places Tuam provided advice regarding this application* Yes, we sought and received support from Creative Places Tuam No, we did not seek or did not receive support from Creatuive Places Tuam If yes, how was this advice received? By phone By email In person 2.1 Tell us about yourself*Briefly describe who you are, what the main focus of your work is, outline your most recent achievement but also give an general overview of your main interests and ambitions as an individual/ group. Maximum characters = 9002.2 Summary of your proposal*Give a brief summary of your proposal (up to three short points). Describe what you want to do, why you want to do it, and how you are going to do it. Maximum characters = 6002.3 Details of your proposal*Please describe your proposal in more detail. What you write here is a key part of the proposal, and should help those involved in assessing your application to understand the dull scope of what you want to do and why it is important to you. It is important to cover both the creative idea and practical aspects of your proposal. This should include details of your creative goals and ambitions, and any other information you consider relevant. Maximum characters = 4800 2.4 Duration Start date* End date* 2.5 Support Material Examples of work*Please include 2-3 images that represent what you do, that you consent to us using in the promotion of this project. Please load .jpeg files with a combined maximum file size of 128MB. Drop files here or Select files Accepted file types: jpg, png, pdf, doc, docx, tiff, Max. file size: 128 MB. 3. Budget*3.1 Tell us what you are going to spend the award money on (max 900 characters)Total amount sought* 4. Declaration Location*I am/ we are an individual of group that lives/ works/ operates in or from Tuam and its surrounding Hinterlands Yes No Timeframe*The work/ event/ activities will take place in 2023 Yes No Outcomes*Project outcomes will be shared with Creative Places Tuam and made available to the community Yes No Media*If our application is successful we agree to take photographs of our ideas/ possible event/ activity and share it with Creative Places Tuam. If we share our idea/ event/ activity online we will acknowledge Creative Places Tuam, Create and the Arts Council and use the appropriate logos Yes No Health and Safety*I/ we acknowledge that all issues related to health and safety, insurance, financial risk and any other matters relating to the work undertaken from this fund remains the sole responsibility of the applicant/ group Yes No Evaluation*I/ we agree to engage with Creative Places Tuam's evaluator, taking part in the evaluation process as needed Yes No 4.1 Contact opt-in*Please note that basic contact information you provide may appear in a database we use to inform beneficiaries and service users about our activities. This includes sharing information with you via an eBulletin and connecting with you by email to organise and promote events relevant to collaborative arts practice and participation in the arts. I agree to allow Create/ Creative Places Tuam to store my or my group’s/ organisation's contact details on a database held for these specific purposes. Yes No 4.2 Declaration*I/ we certify that the information in this application is correct to my/ our knowledge Yes No 4.3 Signature of applicant*Please load a picture of your signature (acceptable files types: .jpg, .png, .pdf, .doc, .docx, .tiff). Maximum file size: 16MBAccepted file types: jpg, png, pdf, doc, docx, tiff, Max. file size: 16 MB.
