2018 FTIF Application Eng.docx

Embassy of the United States of America Yaounde, Cameroon

P.O. Box 817 Yaounde, Cameroon

Fiscal Transparency Innovation Fund Application

The Fiscal Transparency Innovation Fund Application Form is FREE of charge and the Embassy DOES NOT request any payment to receive and evaluate a project.

Funding Opportunity #: AFYDE-FTIF-GR-POLECON-2018

Date: ______________________

1. ORGANIZATION’S INFORMATION (please provide copy of registration certificate and bylaws)

1.1 Organization Identity and Contact Information

Name of group or organization:

Address or P.O. Box:

Telephone:

E-mail (obligatory):

1.2 Organization’s Project Manager (if any)/Alternate Group Contact Information, different from the contact listed above

Title:

Address or P.O. Box:

Telephone:

E-mail (obligatory):

1.3 Description of Organization

When was your organization legalized? (attach paper)

How many members?

How often do you meet?

How are you organized?

What are your main activities?

2. ORGANIZATION’S PAST EXPERIENCE

2.1 Previous projects carried out by the organization

Project 1 Title:

Type:

Main Donor/client:

Group’s contribution = Project total amount =

Year

Project 2 Title:

Type:

Main Donor/client:

Group’s contribution = Project total amount =

Year

2.2 Reference (cite 2 references that know your organization and its activities, but are not members or representative of your organization)

3. PROJECT INFORMATION

3.1 Executive Summary

3.2 Project Identification

Project Title:

Cite Project Deliverables (e.g.: 2 training sessions etc.):

3.3 Project Location

Country

Region

City

NB: Every project considered for funding will be visited before final approval. Please include location plan (sketch/ directions) with your application specifying how to get to your location.

3.4 Project Description

3.4.1 Number of Beneficiaries

State Owned Enterprises __________ Listed Companies_________ Private ___________ Total ____________

3.4.2 Project Background (describe the context of the project)

3.4.3 Project Justification (why is this project necessary?)

3.4.4 Project Objectives (overall goal and specific objectives)

3.3.5 Project Results (give results and state how they shall be measured)

Outputs:

Outcomes:

3.4.6 Project activities

3.4.7 Project Expected Impact (Describe the new situation that will arise from your project. Identify all performance indicators they will be employed.)

Impact:

Performance Indicators:

3.4.8 Project Performance Evaluation (What is your evaluation plan? Also briefly explain your plan and if your project intends to contract an independent performance evaluation.)

3.4.9 Key Personnel + organogram

3.4.10 Project partners (if any)

3.4.11 Project Scope (To what extend does your proposed project reflect a whole -of-government planning process and approach? How will it integrate with or leverage existing programs, local resources, and/or the activities of other donors to greater effect?)

3.4.12 Project sustainability strategy

3.4.13 Project Risks (Identify risk/assumptions and ways to address and mitigate them.)

3.4.14 Project Timeline (You must attach an activity timeline – Appendix D)

· When do you anticipate work will begin?

3.5 Project Financial Summary

3.5.1 General financial details: Attach your project detailed budget narrative and cost estimate to your application (see Appendix B) The budget should be stated in US Dollars and should include a budget detail and a budget narrative that includes the details of the costs associated with each line items and other relevant information to support the proposed budget. There should be a direct relationship between the activities described in the proposal and the budget. All proposals are recommended to use the attached Excel budget format.

What is the total cost of this project?

How much money have you already raised for this project and has it been used?

Who provided this money?

How much will your organization contribute again?

If yes, please provide details:

3.5.2 Embassy grant

How much money are you requesting from the United States Embassy?

FCFA:

How will the money be used?

Signature of President/Delegate/Director

Name: _______________________________

Title: _______________________________

Date: _______________________________

Page | 4 FTIF Application – 2018 image1.wmf