Attachment 1-AOG Proposal Form.docm

Alumni Outreach Grants

Application Form

Grant Proposal Type

Note: You can request up to $5,000 for individual alumni grant proposals, including travel grants, or up to $10,000 for joint alumni grant proposals. Please fill out the budget details form on the last page of the application.

Project Title

Project Summary

Please briefly describe the main purpose of your project. Please stay under 50 words.

If your request is for an international travel grant, please provide the name of the conference, location, dates, and the title of your talk or presentation. An invitation addressed to you by event organizers and a copy of your presentation should be attached to this form.

Grant Applicant (Project Leader/Main Point of Contact)

City Name Postal Code

Alumni Team Information

Please list a max of two other U.S. Exchange Alumni to be involved in the project.

If you are applying for an individual grant, please check the box below.

Alumni Team Member 1 First Name Last Name

Exchange Program Name and Year e-mail phone #

Alumni Team Member 1 First Name Last Name

Exchange Program Name and Year e-mail phone #

☐ I am applying for an individual grant. No other alumni will be involved.

Target Audience

Please define your target audience and estimate the number of individuals to be reached.

Primary Location of Project

If the project is taking place in multiple regions or cities, please enter all locations separated by a comma.

Program Goals and Objectives

Please define the problem that is the subject of your grant application.

What will this project achieve? What are the expected long-term effects of the project?

Include the main goals and timeline with major milestones. Limit your response to 300 words.

Impact and Evaluation

What difference will it make to your region, community, workplace or to Uzbekistan at large? How will you measure the impact and success of this project? Limit your response to 150 words.

Project Dates

Please state the length of the project. Alumni Outreach Grants are given for up to twelve months. Even if approved, funds may not be available for as long as two or three months from the time the application is submitted.

(For example, if the applicant submits the proposal in September, but states that the project must begin in September, the Embassy may reject the proposal as being unrealistic on this basis.)

Project start date: Select tentative start date Project end date: Select tentative end date

Grants Received

Please provide information, including the amount, of all U.S. Government funding that you have received for any project in the last five years. This also includes projects unrelated to the one for which you are seeking an Alumni Outreach Grant.

If you answered Yes to the last question, please indicate the source of funding and cost share amount under in-kind contribution category of the budget form below.

Budget Summary

PLEASE READ THIS THOROUGHLY BEFORE YOU PROCEED TO THE BUDGET PORTION.

In order to be sure that the Embassy understands why there is a need for funding, you must prepare a line-by-line list of expenses that will be incurred by this project. The budget should be prepared in a logical manner and offer enough detail that a reviewer will be able to understand exactly what the figures mean and how those figures were determined.

· The use of "miscellaneous expenses" as a budget item is unacceptable.

· Cocktail parties, receptions, and entertainment are not allowable expenses. Coffee breaks for conferences and seminars must be justified and not more than one per day is allowable.

· Although generally not allowed, requests for salaries or honoraria must be justified in the context of the project’s goals. The salary should be calculated based on the total number of hours worked for the duration of the project. The salary level should be reasonable and no higher than other local salaries.

· Grantees are responsible for paying all taxes on salaries and honoraria. The Alumni Outreach Grant Program does not fund social taxes separately. Organizations and individuals will be responsible for paying those taxes on their own from any salaries provided in the grant.

· All project expenses must be calculated in U.S. Dollars.

· All project expenses should be calculated in advance and must be realistic. The Alumni Outreach Grant Program will not authorize any funds if there is any question about the budget.

Budget Categories Overview Personnel Costs: salaries for recipient organization’s staff/alumni project members working directly on project. If salary is requested, detailed duties and responsibilities of each project member should be enclosed.

Travel: transportation, hotels, per diem, visa fees, inoculations, and insurance.

Equipment: property with a per unit cost of at least $5,000.

Supplies: property with per unit value under $5,000. This includes office supplies, stationery, printers, laptops, and other items.

Contractual: contracts under the grant, subawards, consultants.

Other Direct Costs: all other project-related costs – detailed, not just ‘miscellaneous.’ This includes cell phone/internet costs, bank fees, postage, etc.

In-kind contribution: if applicable, please indicate any in-kind or other contributions such as voluntary work, use of premises, classroom supplies, equipment or payment of a program event from your own funds (e.g. venue rental, printing of announcements, meals, travel, etc.).

☐ By checking this box, I certify that I have read and understood the budget instructions.

Budget Breakdown (In U.S. Dollars)

APPLICATION CHECKLIST

Please do not submit your application until you have responded to all questions.

Signature: Please type your full name Date: Click or tap to enter a date.

PROPOSALS TOGETHER WITH SUPPORTING DOCUMENTS

MUST BE SENT TO:

Tashkent-Alumni@state.gov image1.png