APPLICATION FORM FOR BASA EDUCATION PROGRAMME 2014

FOR REGISTERED ARTS ORGANISATION ONLY

Organisation details

Name of Organisation:______

Postal address: ______

______

Physical address: ______

Telephone and contact person:______

Email and website:______

Type of registered entity (i.e. NPC, Pty(Ltd) etc:______

Head/Director of organisation: ______

Deputy/ Assistant:______

Please answer the questions below to give us a clear picture of your organization and how you operate and what your challenges are.

1.How long has your organisation existed?______

2.How is your entity constituted? Y /N

______

3Explain company policy/constitution/mission statement (or attach copy)

______

______

______

  1. Who are the organisation’s stakeholders?

Persons/Organisations

5.What does your organisation do?

______

______

______

6.What are your competencies?

______

______

______

7.How do you fund your activities?

______

______

______

8.Do you have any profit centers?

______

______

______

9.Who are your customers/ audiences?

______

______

______

10.How do you sustain your customer base?

______

______

______

11.What obstacles are you facing at present?

______

______

______

12.Who are your competitors? Please list them:

a)______

b)______

c)______

13.What is your most urgent priority? Give details:

______

______

______

14.Why do you want to join the programme?

______

______

______

15.We require regular reporting. Are prepared to give regular feedback, monitor progress and submit reports to the funders of the programme? Yes/ No

______

16.Who would implement the strategies taught?

______

17.Are you confident the strategies could be implemented?

______

18.Which representative from your organisation will provide report back?

______

I hereby confirm that our MD/CEO is aware of our application and fully supports it.

Signed:______Date:_____/_____/______

Please attach the following documents – company structure and your branding material (logo, brochure, programmes etc.)

If you have any queries, please phone Diana Williams on 011 447 2295 or 073 3059031 or e-mail

T + 27 11447 2295 / 2182/ 2743 F +27 11447 2364A 163 Jan Smuts Avenue • Parkwood • 2193 •Johannesburg P P.O. Box 962 • Parklands • 2121

• Mr. Kwanele Gumbi (Chairman) • Mr. Richard Cock • Mr. Mandla Langa • Mr. Gianni Mariano • Mr. Monna Mokoena

• Mr. Herman Bosman • Mr. Andre Le Roux • Ms. Gabriela Palacios-Flusk • Ms. Florence Thom • Ms. Michelle Constant

• Mr. Matthew van der Want • Ms. Mandie van der Spuy • Ms. Gail Walters • Mr. Carel Nolte

Chief Executive Officer: Michelle Constant

Company Registration 1997/001920/08