Applicant Organizational Information.docx

Applicant Organizational Information

Instructions: The Applicant Organizational Information template should be filled out in its entirety. Please note that the response “Not Applicable,” or “N/A,” is generally not acceptable. Instead, a sufficient explanation should be provided to explain why an item is not applicable.

GENERAL INFORMATION

1. Organization Name:

2. Is your Organization incorporated, registered, or licensed as a legal entity: □ Yes □ No (attach copy)

If Yes:

Authority under which Registration was obtained:

Date of Registration (MM/DD/YYYY):

3. Do you check reference of your employee/volunteers before hiring/assigning them?

□ Yes □ No

4. Are there liens, debts or any other financial burden against your organization?

□ Yes □ No

If Yes please attach an explanation in a separate document.

6. Has your organization ever declared bankruptcy or gone through re-organization?

If Yes please attach an explanation in a separate document.

ORGANIZATION STRUCTURE

1. How is your organization governed?

If “others” specify:

2. How many employees are employed by your organization? Or how many work on voluntary basis?

3. Is your organization registered with System for Award Management (SAM)? (If yes, please attach a screenshot of your SAM registration)

If No, please explain why

4. Please provide your organogram/organizational chart in a separate document.

FINANCIAL AND ACCOUNTING MANAGEMENT

1. What is the financial year of your organization?

(e.g. Jan 1 - Dec 30, Oct 1 – Sept 30, or June 1 - May 30)

(MM/DD/YYYY- MM/DD/YYYY)

2. Will the grant funds you are currently requesting be deposited in a separate bank account?

□ Yes □ No

3. Which position in your organization will be responsible for financial record keeping and timely submission of financial and program reports?

4. Will you be able to maintain an accounting system (software or excel spreadsheet) that can separately track all drawdowns and grant expenditures?

□ Yes □ No

BUSINESS MANAGEMENT SYSTEMS

1. Will activity/time records be maintained for each employee dedicated to the project supported by USG grant? (e.g. full-time engagement or part-time engagement)

□ Yes □ No

Please explain:

2. Does your organization follow Procurement Policies, whereby multiple quotations are collected and due diligence is applied before the final purchase?

3. Does your organization have written job descriptions for personnel?

□ Yes □ No

4. Are appropriate duties separated to ensure one individual (i.e., project or financial) is not controlling all aspects of a transaction/process?

□ Yes □ No

If No, please explain:

6. Has your organization received U.S. Government grant funds before?

□ Yes □ No

6.1 Please provide the following information on awards or funding received in the last five years. Please specifically note if funds are U.S. Government (USG) funds.

Name of Donor

Amount

Period Place of Implementation

Signature: ____________________ Title: ____________________________

Telephone #: ____________________ Email: _____________________________ Program Title: ____________________________________________________ Grant Amount Requested: _________________________________ Date: ______________