2017 APPLICATION FOR INFRASTRUCTURE: Full ECD Centre, Kitchen, Toilet or Classroom Container
• Breadline Africa has an interest in supporting early childhood development projects.

• Breadline Africa will prioritise projects within a 100km radius of Cape Town.

• As a general rule, Breadline Africa will NOT place infrastructure on privately owned property.

• Any site must have appropriate approval (i.e. permit and or zoning certificate where applicable).

• Applications for office and sick bays for ECDs are not a priority for Breadline Africa
• The following applications will NOT BE CONSIDERED:
o Skills development projects
o Start-up ventures (no history of operation)
o Adult and youth projects
o Requests for storage facilities
o Requests for housing / old age homes / accommodation
o Incomplete application forms

• NB: Upon approval, A R5000.00 deposit is required for the infrastructure to be delivered. These funds will be ploughed back into the beneficiary project.

Please complete this form in as much detail as possible to provide a clear understanding of the project.

Submit your completed application form and ALL supporting documentation to Ms Gail Dreyer:

Tel: +27 21 418 0322
Fax: +27 21 418 6406
Email: allocations@breadlineafrica.org.za
Post: Breadline Africa,
PO Box 6, Green Point, Cape Town, 8051
Physical: 2 Somerset Road, Green Point, Cape Town, 8005


Project Name
Your answer
Project Physical Address
Your answer
Project Postal Address
Your answer
Region (Province)
Your answer
GPS Coordinates (or Landmark i.e. Primary School)
Your answer
Project Contact Name
Your answer
Contact Details
Cell and Landline
Your answer
E-mail address
Your answer
Project Website Address
Your answer
Primary Activity Area
e.g. creche, soup kitchen etc.
Your answer
How long has this project been in existence?
Since
Your answer
Application Sent Via
Required
Application Date
MM
/
DD
/
YYYY
Is the organisation registered as an NPO / NGO / PBO / CBO?
Required
If yes, provide the Registration No.
Your answer
The container you are applying for is to be used as a
Required
Are you a
Required
What infrastructure do you currently have? (where are you working from currently)
Please give details and e-mail or fax pictures if possible
Your answer
What is your organisational structure / constitution?
(Please e-mail or fax a copy of your constitution)
Your answer
Founder / Principal: Full Name
Your answer
Educator 1: Full Name
Your answer
Educator 2: Full Name
Your answer
Other staff: Full Name
Your answer
Other staff: Full Name
Your answer
Is your project already working in partnership with other relevant groups in the district / province?
Yes
No
Department of Social Development 
Department of Rural Development
Department of Basic Education
Department of Health
ECD Forum
ECD Developmental organisation
Other
Provide the name of organisation(s) and year that the partnership started
Your answer
Literacy Developmental organisation
Required
Provide name of organisation(s) and the year the partnership started
Your answer
Project Summary
(tell us more about your project)
Your answer
Primary activities
(tell us more about your project and outline the educational programmes that you run)
Your answer
Secondary activities
Your answer
Beneficiary Demographic information
Number of children between 0-5
Your answer
Number of children between 5 and 6
Your answer
Number by gender
Female and Male
Your answer
How often will the infrastructure you request be used per week?
Your answer
Containers will rust and require basic maintenance over time. Should you qualify to receive a container, will you have resources to maintain it?
Required
If yes, explain where these resources will come from?
Your answer
Do you have land / site available to place the infrastructure?
Required
Do you have a title deed to this site?
Required
If No, do you have a letter from the Municipality stating that they have given their approval / permission to use this site?
(Please e-mail or fax a copy of the letter of consent from the Municipality with your application)
Required
If applying for an ECD container, do you have an ECD zoning certificate?
Required
Have you discussed your application with your community / school governing body / parents? If yes do you have their approval?
Your answer
Details of the proposed site
Yes
No
Is there electricity on the proposed site?
Is there water connection on the site?
Is there sewerage system on the site?
Is the site fenced?
If no, will you be able to fence it prior to receiving a container?
Have you checked with your municipality regarding architectural plans for the container(s) to be placed on this site?
If yes, do you have architectural plans for what you need?
If yes, please attach as supporting documentation (please note that Breadline Africa will not draw up or submit any plans)
Your answer
How far is the nearest municipal connection point?
Your answer
Please state how you heard about Breadline Africa
Your answer
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