2024 ASSH Application Form.docx
DOCX document 28 KB Posted
- Attached to
- Ambassador's Special Self-Help Fund (ASSHF)
- Opportunity number
- DOS-RWANDA-PE-2024-01
- Issued by
-
Department of State US Embassy Kigali
About this file
This document is an application form for the 2024 Ambassador's Special Self-Help Fund (ASSH), a grant program administered by the U.S. Embassy Kigali in Rwanda. The ASSH program provides small grants ranging from $1,000 to $15,000 to support community-based development projects that improve economic and social conditions at the grassroots level. Eligible applicants are cooperatives registered with the Rwanda Cooperative Agency and non-governmental organizations (NGOs) registered with the Rwanda Governance Board. The application requires details on the proposed project, including the project title, location, target population, goals and objectives, implementation plan, monitoring and evaluation, key personnel, and a detailed budget. The completed application must be submitted by May 31, 2024. The ASSH program is funded under the U.S. Ambassadors' Special Self-Help program (CFDA 19.220), which allows U.S. embassies to respond quickly to local requests for small community development projects.
Application Form
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Text version
2024 Ambassador’s Special Self-Help Fund Application Please complete all questions on the application. The document should not exceed 5 pages. Incomplete applications with missing supporting documentation (please see complete list on website) will not be considered.
1. Name of Organization:
a. Address:
2. Employee Contact:
a. Title:
b. Email:
c. Cell Number:
3. Project title:
4. Location of Project:
5. Population to be served:
6. Number of direct project beneficiaries:
7. Number of indirect project beneficiaries:
8. Executive Summary/Purpose (max 400 words):
9. Project description (how the project will be carried out—max 500 words):
10. Project Goals and Objectives (the “goals” describe what the program is intended to achieve. The “objectives” refer to the intermediate accomplishments on the way to the goals. These should be achievable and measurable.):
11. Proposed Program Schedule and Timeline: The proposed timeline for the program activities. Include the dates, times, and locations of planned activities and events.
12. Program Monitoring and Evaluation Plan (an explanation of how the activities will be monitored to ensure they are happening in a timely manner and how the program will be evaluated to make sure it is meeting the goals of the grant):
13. Key Personnel (names, titles, roles, and experience/qualifications of key personnel involved in the program, as well as the proportion of their time that will be devoted to supporting this program):
14. Sustainability/Project Follow up (the applicant’s plan for continuing the program beyond the grant period, or the availability of other resources, if applicable):
15. History of NGO (a description of past and present operations, showing ability to carry out the program, including information on all previous grants from the U.S. Embassy and/or U.S. government agencies or other sources of current funding – max 200 words):
16. Budget:
| Category |
| Description/Details |
| Amount Requested in USD |
Personnel and Fringe Benefits
Travel
Equipment
Supplies
Contractual
Other Direct Costs
Indirect Costs
Total Requested
Contributions
Cost Share
Project Total
Note: You may be asked to submit a detailed budget in a spreadsheet format.
17. Budget Narrative:
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