Application Form FY2021 v8 final.docx

U.S. EMBASSY BELGRADE, SERBIA

Public Affairs Section (PAS)

GRANT APPLICATION FORM

FY (Fiscal Year) 2021 Revised March 2021 (v8)

IMPORTANT: While filling out this form, please pay careful attention to all the instructions in Appendix A of the Notice of Funding Opportunity (NOFO) or the Annual Program Statement (APS). (All NOFOs and APS can be found on our website at https://rs.usembassy.gov/education-culture/grants-programs.) If your application is incomplete, it will be considered technically ineligible, and your project will not be considered for funding by the review committee.

Please check the appropriate box:

☐ This is the first time you are applying for a Public Affairs Section (PAS) grant.

☐ You have applied for one or more PAS grants in the past, but you have never been approved for funding.

☐ You have received one or more PAS grants in the past. Note: You must provide complete responses in section “y” below. Failure to do so will result in your application being considered technically ineligible.

Are you yourself (if applying as an individual) or is a key leader in your organization an alumnus, i.e., a past participant, of an exchange program supported by PAS, the U.S. State Department’s Bureau of Educational and Cultural Affairs (ECA), or another part of the U.S. Government? (Please go to https://rs.usembassy.gov/education-culture/exchange-programs/ to see our current “List of Exchange Programs in Serbia Since 2001.”) ☐ No.

☐ Yes. Please tell us:

· the name of the exchange program:

· the dates when the program took place (approximately):

· (if applying as an organization) the name of the person who participated in the exchange program and his/her position in your organization:

a. Date of Application

b. Grant Program

c. Program Theme

d. Project Title in English (Max 100 characters)

e. Project Title in Local Language (Max 100 characters)

f. Legal Name of Applicant (Individual or Organization) in Local Language

g. English Translation of Organization Name (Optional)

NCAGE Number:

SAMS.gov registration: ☐ Completed. ☐ Started process.

i. Contact Information

j. Website and/or Social Media

k. Grant Amount Requested from PAS

Anticipated start date:

Anticipated end date:

Total program length: ___ months (Please do build in time to assess or evaluate the results or impact of the project.)

PROJECT PROPOSAL

m. Brief Project Summary (Max 1000 characters)

n. Problem or Challenge Statement (Max 2000 characters)

o. Overall Project Goal(s) (Max 500 characters for each box checked)

Select up to three:

☐ Promote general awareness about an issue.

☐ Educate, teach, or train others.

☐ Promote dialogue or debate.

☐ Shift attitudes or opinions.

☐ Inspire action or change.

☐ Create or strengthen linkages or connections.

☐ Strengthen the capacity of a group or organization.

Brief explanation:

p. Participants, Audiences, and Beneficiaries (Max 2000 characters)

Primary:

Secondary (if applicable):

Location(s):

☐ Belgrade ☐ Bujanovac ☐ Kragujevac ☐ Nis ☐ Novi Pazar ☐ Novi Sad ☐ Subotica ☐ Vranje ☐ Other:

q. Approach and Justification (Max 2000 characters)

r. Project Timeline and Program Activities (Max 5000 characters)

s. Defining Measurable Objectives (Max 250 characters)

t. Monitoring & Evaluation (M&E) Plan: Tracking Progress and Measuring Impact, Changes, or Results (Max 2000 characters)

u. Multiplier Effect/Longer Term Impact/Sustainability (Max 1000 characters)

v. American Element or Angle (Max 500 characters)

BACKGROUND

w. Background on Applicant (Max 2000 characters)

x. Key Personnel, Partners, and Contractors

y. Current or Completed U.S. Embassy or U.S. Government Grants

For each grant, provide the following information:

· Project or activity name:

· Source of funding:

· Grant program:

· Amount:

· Dates:

· Short description:

· Analysis:

· Links:

Argument or case for additional funding:

If running concurrent PAS projects:

z. Current or Completed Activities Funded by Other Donors

For each activity, provide the following information:

· Project or activity name:

· Donor/sponsor:

· Amount:

· Dates:

· Short description:

· Analysis:

· Links:

TOTAL PROJECT COST

aa. Total Project Cost, including Contributions, Donations, and Cost Share

Applicant

Partner

Partner

Other Funding Sources (CONFIRMED)

Other Funding Sources (CONFIRMED)

Other Funding Sources (PENDING)

Other Funding Sources (PENDING)

TOTAL PROJECT COST

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