1. PD Jerusalem Application Proposal Form.docx

U.S. Embassy Grants Program Application

Read the instructions provided in this document carefully.

Applications that do not follow the guidelines and instructions provided within this form will not be reviewed. Applications may not exceed 10 pages.

Questions can be directed to: TelAvivGrants@state.gov

1. EXECUTIVE SUMMARY

1.1 Program Overview: Please provide a short outline of the proposed project (word limit 1200 characters)

2. GENERAL INFORMATION

Applicant Organization:

Organization Name:

Address:

Street Address

City/Town

District

Website (if applicable)

Social Media Page (if applicable, platform and link)

Organization Director:

First Name, Last Name

Title

Telephone

Mobile

Email

Preferred method of contact

3. BACKGROUND OF ORGANIZATION

3.1 Registration Information:

Is the organization registered, incorporated, or licensed as a legal entity? ☐ Yes* ☐ No *If yes, attach a copy of organization’s registration form.

Date of incorporation or registration (MM/DD/YYYY):

Date organization was founded:

How organization is primarily funded:

CVs attached in Appendix A for each staff member on the project? ☐ Yes ☐ No

3.2 Organization Mission:

3.2.1 What is the purpose (or mission statement) of your organization? (word limit 500 characters)

3.2.2 How, if at all, is your organization different than other organizations that work in this field? (word limit 500 characters)

3.3 Summary of Expertise: Detail your past work in this area so the U.S. Embassy can better understand your organizations’ record of performance and ability to succeed in future projects.

3.3.1 Describe past work in this topic area. (word limit 700 characters)

3.3.2 Describe any best practices or lessons learned in previous projects. (word limit 700 characters)

3.4 Project Partners: From previous work in this area, have you developed networks with other organizations or groups that also work in this field? Are you going to carry out project activities in partnership with other organizations?

If yes, list the organization name and describe their role in the project. (word limit 400 characters)

4. PROPOSED PROJECT DESCRIPTION

4.1 Project Information

Project Name:

Duration (months)

Projected Start and End Date:

Funding Requested

4.2 Problem Statement

4.2.1 Problem Statement: What problem do you intend to address by implementing this grant? (word limit 1000 characters)

4.2.2 Problem Statement Justification: What evidence, experience or other information supports your problem statement? Why is this a priority? (word limit 1500 characters)

4.2.3 Project Objective(s): Which objective(s) from the NOFO is this proposed project seeking to address? (word limit 1000 characters)

4.3 Participants

4.3.1 Describe the target beneficiaries in this program. Be as specific as possible. Possible participant characteristics may include age-range, education level, geographic location, occupation, level of education, etc. (Word limit 500 characters)

4.3.2 Why are these individuals an important population to reach for your project? (Word limit 500 characters)

4.3.3 What are the steps your organization will take to ensure access to these participants? (Word limit 500 characters)

5. PROPOSED WORK PLAN

5.1. Proposed Project Activities: Provide a detailed work plan that clearly identifies each step you will take to plan and implement this project. Please include an activities calendar divided by months/weeks and responsible people as in the example below.

Planning Activities (meetings, obtaining venues, equipment and/or staff)

(for example: staff time, and funding for office space)

Major Project activities (trainings, workshops, events, campaigns, etc.)

Follow-on activities

6. EXPECTED PROJECT OUTCOMES

6.2. Project Outcomes and Performance

6.2.1 Expected Outcomes: What specific types of change(s) do you expect will occur in participants’ knowledge, attitudes, skills, behaviors, etc. during the grant as a direct result of program activities? In other words, what will success look like in this project? Examples may include:

· Example: Participants will increase their understanding on labor laws as a result of program activity

· Example: Participants will increase their skills on branding and social media marketing as a result of program activity

6.2.2 Performance Indicators: Describe how you will measure success of the program activities by listing specific, measurable indicators you will track over the course of the program. Examples may include:

· Example: 100 aspiring entrepreneurs completed training in branding and social media marketing (SMM) skills

· Example: 20 hours of technical training completed on branding and SMM strategies

· Example: 80% of participants report increased abilities in branding and SMM strategies

· Example: 150 social media posts published on Instagram following a SMM training for entrepreneurs trying to expand their client base

6.2.3 Data Collection Methods: What data collection methods will you use to verify, confirm, and track success? Examples may include:

· Follow-up interviews or focus groups with participants,

· Pre-and post-program surveys/questionnaires,

· Direct observation of behaviors, etc.

· Attendance sheets

· Program reports

· Host country government reports/data

· Official reports

6.3. Implementation Challenges

6.3.1. What potential obstacles exist that could affect the implementation of the program? For example: obtaining government approval, media/press concerns, availability of electricity/internet (word limit 1200 characters)

6.3.2. How does your program plan to address the obstacles listed above? (word limit 1200 characters)

7. PROGRAM ADMINISTRATION

7.1 Key Personnel

7.1.1 Describe the role & responsibilities of the key personnel/project team involved in the implementation of the program. (word limit 1000 characters)

8. PAST GRANTS

8.1 Grants funded by U.S. Embassy

Have you ever received a previous grant from the U.S. Embassy? Public Diplomacy Section (PDS), USAID, or another US Government entity? ☐ Yes ☐ No

If yes, list:

Donor Organization:

Project name:

Project amount:

Period of performance:

Results achieved on this program to date:

8.2 Grants funded by other donor organizations

Have you ever received funding from any other donor organization? ☐ Yes ☐ No

If yes, list:

Donor Organization:

Project name:

Project amount:

Period of performance:

Results achieved on this program to date:

9. PROPOSED BUDGET

9.1 Budget Summary

Total Requested

Note: You are required to submit a detailed budget in the template spreadsheet (Attachment 3)

10. CERTIFICATIONS

I am aware that any false statements or claims may disqualify my organization from receiving this and any future awards.

☐ I agree.

I confirm that the project described in my grant application does not promote any activities that are contrary to the following Executive Orders:

· Executive Order 14287: “Protecting American Communities from Criminal Aliens.”

· Executive Order 14173: "Ending Illegal Discrimination and Restoring Merit-Based Opportunity

· Executive Order 14168: Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government

☐ I agree.

By signing this application, I certify that the statements contained in this form are true, complete and accurate to the best of my knowledge.

Name of Authorized Representative

Signature of Authorized Representative

Date Signed