2022 DemCom Application.docx

U.S. EMBASSY DEMOCRACY COMMISSIOM SMALL GRANT PROGRAM

APPLICATION FORM

DEADLINE: FEBRUARY 25, 2022, 6 P.M.

Completed application and required supporting documents must be submitted electronically to: TbilisiGrants@state.gov

Please include the program name - 2022 Democracy Commission in the subject line.

Information About Organization

Organization name (in Georgian)

Organization name (in English):

Organization representative (Top executive):

Legal address of the organization:

Physical address of the organization:

Contact information: Tel/Mobile, E-mail, Webpage.

Information on registration:

Date and Place of registration:

Tax identification number:

Registration status on SAM.gov: Activation date:

Expiration date:

Mandatory application forms:

1. SF-424 (Application for Federal Assistance – organizations)

2. SF-424A (Budget Information for Non-Construction programs)

3. SF-424B (Assurances for Non-Construction programs)

4. Democracy Commission Application form

5. 1- page CV of project team leader

6. Support Letter/s

7. Copy of registration on sam.gov

8. Copy of the NGO registration certificate

Please follow guidelines in the 2022 Democracy Commission Small Grant Program Notice of Funding Opportunity (NOFO) when completing the application.

The application package must be archived only into ZIP archive. RAR archived packages will not be accepted. emails exceeding 6MB and RAR/ZIP files will not be accepted.

DETAILED INFORMATION

Name of project:

Amount requested:

Project period:

(A project should not exceed 12 months. Recommended start time for the project is March 2022)

Executive summary of the project:

Project Goals and Objectives:

Project Justification/Problem Statement:

Detailed Description of the Project Activities:

ACTIVITY TIMETABLE

Project Beneficiaries:

Project Partners (if applicable)

Expected Results:

Future Funding or Sustainability of Project:

Logical Framework for Monitoring and Evaluation (see the example below)

Goal:

Expected Results:

Activities:

Please refer to the Program Monitoring and Evaluation Plan in the 2022 Democracy Commission Small Grant Program Notice of Funding Opportunity (NOFO) while completing this part. Feel free to submit an additional Logic Model, as needed.

PROJECT BUDGET

(In USD and excludes VAT)

BUDGET:

BUDGET CATEGORIES

NO of Units X

Price Per Unit

Applicant’s Share of the Cost

U.S. Share of the Cost

TOTAL $

PERSONNEL

SUBTOTAL

TRAVEL

SUBTOTAL

EQUIPMENT

SUBTOTAL

SUPPLIES

SUBTOTAL

CONTRACTUAL

SUBTOTAL

OTHER DIRECT COSTS

SUBTOTAL

TOTAL

BUDGET NARRATIVE

After filling out the SF-424A budget application form, use a separate sheet of paper to describe each of the budget expenses in detail.

The budget narrative should follow the actual budget presentation above and describe in some detail the costs presented in the budget. In other words, the narrative explains, line by line, what the numbers mean and how they were determined. (For example, Travel: $3,000. Explanation: Two-day conference in (location) for 30 participants with a 2 x $50 travel grant to each participant for room, board, and transportation costs.)

IMPLEMENTATION TEAM

Name

Position Title and Description % of time spent of project-related activities Contacts:

Cell phone # Email:

BACKGROUND:

Brief information about applicant organization

· Organization mission and objectives

· List of implemented projects/received funds/donors

· Significant achievements

OTHER USG FUNDING:

All previous U.S. Government funding, including previous Democracy Commission grants as well as USAID or NED funded projects. Please list year, amount of project and name of the project.

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