ApplicationFormat.docx

U.S. Embassy Grants Program

APPLICATION FORMAT FOR ORGANIZATIONS

Last Updated: 01/04/2023

Read carefully the instructions supplied with this document.

The applications that do not follow the guidelines and the instructions provided with this form will not be reviewed.

Prepare your answers using this format and submit them using the following link:

https://forms.office.com/g/QtwWTqnUEk

IMPORTANT:

· This document should be completed in English Language

· Please prepare all your answers in a word document and then use this form to copy-paste and submit the answers.

· When you submit the application, you will receive a confirmation message. Reply to that message including the attachments required for this submission.

Funding Opportunity

Please select funding opportunity from the list on the website.

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Applicant Organization

Please provide details about the applicant organization. Please enter the Legal Name exactly as it appears on the registration documents. Bank Account Holder Name is the Name of the organization as it appears in your bank account.

SAM.GOV registration is mandatory for all grants. Refer to the instructions included in the Notice of Funding Opportunity.

Fiscal Code (non-US) or EIN (U.S.) is a mandatory field. The fiscal code is used to check the legal status and validate the registration of the applicant organization.

Legal Name Please enter the Legal Name exactly as it appears on the registration documents. Do not translate. Enter the legal name of the applicant that will undertake the assistance activity. This is the organization that has registered with the System for Award Management (SAM).

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Type of applicant Select the applicant type from the list

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Unique Entity Identifier (UEI):

Enter the organization’s UEI received from SAM.gov. The UEI is a unique 12 character organization identifier.

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EIN (US Organizations) or Fiscal Code (Moldovan organizations)

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Address: Street:

Enter address: Street

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Address: City Enter address: City

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Address: State/Raion Enter address: State or Raion

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Address: ZIP/Post code Enter address: ZIP code (US) or Postal Code

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Address: Country Enter address: Country

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Authorized Representative

Please provide information about the name of the person who is authorized to sign a grant agreement on behalf of the organization.

A copy of the governing body’s authorization for you to sign this application as the official representative must be on file in the applicant’s office.

Authorized representative First Name:

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Authorized representative Last Name:

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Authorized representative Job Title:

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Authorized representative Telephone:

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Authorized representative Mobile Telephone:

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Authorized representative Email:

Contact Person (Project Coordinator) Please provide information about the person to be contacted on matters involving this application.

Contact Person First Name:

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Contact Person Last Name:

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Contact Person Job Title:

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Contact Person Telephone:

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Contact Person Mobile Telephone:

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Contact Person Email:

Project Description

Project Title:

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Project Start Date

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Project End Date

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Areas affected by Project

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Executive Summary/Project Abstract summary (4000 characters) Ensure the Project Abstract field succinctly describes the project in plain language that the public can understand and use without the full proposal. Use 4,000 characters or less. Do not include personally identifiable, sensitive or proprietary information. If the application is funded, your project abstract information (as submitted) will be made available to public websites and/or databases including USAspending.gov.

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Project Justification: (4000 characters) Use the space below to justify why your project is important. Write about the problem the project intends to address and qualifications of the organization. Explain the need of the project.

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Project Goal and Objectives (4000 characters) In this section of the proposal, state the overall project goal and the specific objectives that will be achieved during the project.

Project Goal The project goal refers to a general, long-term change, such as a change in attitudes or in public policy.

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Project Objectives (4000 characters) Objectives refer to the intermediate changes, are more specific than goals and refer to a specific location and time. Unlike a goal, which a project will only partially contribute to achieving, the project objectives do need to be achievable and measurable within the scope of the project. Make sure your objectives are SMART (Specific, Measurable, Appropriate, Realistic and Time-Bound) sdfsdfsdf

Project Activities In this section of the proposal, provide more details about the specific activities that will be conducted. The activities should support the achievement of the objectives. You may add up to 10 activities.

Activity 1: Title:

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Activity 1: Description (max. 4000 characters) s

Activity 2: Title:

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Activity 2: Description (max. 4000 characters)

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Activity 3: Title:

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Activity 3: Description (max. 4000 characters)

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Activity 4: Title:

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Activity 4: Description (max. 4000 characters)

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Activity 5: Title:

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Activity 5: Description (max. 4000 characters)

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Activity 6: Title:

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Activity 6: Description (max. 4000 characters)

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Activity 7: Title:

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Activity 7: Description (max. 4000 characters)

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Activity 8: Title:

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Activity 8: Description (max. 4000 characters)

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Activity 9: Title:

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Activity 9: Description (max. 4000 characters)

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Activity 10: Title:

Activity 10: Description (max. 4000 characters)

Monitoring and evaluation (4000 characters) This section provides details on how the effects of the intervention will be measured.

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Key Personnel (4000 characters) Include information about the project team. Who will work on this project? What are their qualifications and responsibilities?

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Project Partners (4000 characters) Who will be your partners in the implementation of this project? Describe the role of each partner.

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Strengths and Innovation (4000 characters) This section of the proposal is a place for you to describe what is innovative or interesting about your project, what sets it apart from other projects.

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Sustainability (2000 characters) Sustainability refers to the ability of a project to continue once the initial grant or external source of funding has ended.

Budget Summary Include information about estimated funding requested from the U.S. Embassy

Personnel Include the total for salaries of temporary or permanent staff who will be working directly for the program. Please take the information from the Summary section of the Detailed Budget Template

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Fringe Benefits Include the benefits of temporary or permanent staff who will be working directly for the applicant on the program. Check with the program if these benefits are allowable.

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Travel Include the costs of travel (tickets, fuel, car rent, accommodation, per diem) for this program, for program staff, consultants or speakers, and participants/beneficiaries.

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Equipment Describe any machinery, furniture, or other property that is required for the program, which has a useful life of more than one year (or a life longer than the duration of the program), and costs at least $5,000 per unit. For example, a laptop of $1,500 should not be included in this category because it is less than $5,000.

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Supplies List and describe all the items and materials, including any computer devices, that are needed for the program. If an item costs more than $5,000 per unit, then put it in the budget under Equipment. Consider grouping small expenses (For example, include Conference supplies for two events instead of separate lines for expenses like pens, folders, markers, paper, etc).

Construction Costs

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Contractual Describe goods and services that the applicant plans to acquire through a contract with a vendor. All relevant taxes should be included. Also describe any sub-awards to non-profit partners that will help carry out the program activities.

Other Direct Costs Describe other costs directly associated with the program, which do not fit in the other categories. For example, shipping costs or applicable taxes, . All “Other” or “Miscellaneous” expenses must be itemized and explained.

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Indirect Costs These are costs that cannot be linked directly to the program activities, such as overhead costs needed to help keep the organization operating. If your organization has a Negotiated Indirect Cost Rate (NICRA) and includes NICRA charges in the budget, attach a copy of your latest NICRA. Organizations that have never had a NICRA may request indirect costs of 10% of the modified total direct costs. Please confirm if program supports indirect costs.

Non-Federal Funding

Applicant Contribution Enter 0 if you do not have applicant contribution

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Contribution by other organizations Enter 0 if you do not have contribution by other organizations

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Estimated Program Income Enter 0 if you do not anticipate having program income

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Certifications Is the Applicant Delinquent On Any Federal Debt?

Select the appropriate box. This question applies to the applicant organization, not the person who signs as the authorized representative. Categories of federal debt include; but may not be limited to: delinquent audit disallowances, loans, and taxes. If yes, include an explanation in the field below.

☐ Yes ☐ No

If Yes:

Federal Debt Delinquency Explanation:

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Certifications The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions.

By submitting this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

PLEASE SUBMIT THE INFORMATION FROM THIS DOCUMENT ELECTRONICALLY IN ORIGINAL FORMAT.

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