Attachment 6. Organization Proposal Template.docx

U.S. Embassy Tashkent Grants Program

APPLICATION FORMAT

Last Updated: 09/17/2010 Page 2 of 3

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.

1. GENERAL INFORMATION:

1.1. Applicant Organization

a. Organization (English):

b. Organization (Original):

c. Address: d. City/Town: e. District:

f. Website: g. Tax Code:

1.2. Organization leader

a. Last Name: b. First Name: c. Title:

c. Tel: d. Mob: e. Fax: f. E-mail:

2. BACKGROUND OF ORGANIZATION:

2.1. Description

2.2. Past Grants (U.S. Embassy)

2.3. Past Grants (Other)

3. PROJECT DESCRIPTION:

3.1. Project information

a. Project Name:

b. Duration (months): c. Start date (mm/dd/yyyy): d. End date (mm/dd/yyyy):

3.2. Executive summary:

3.3. Project Justification:

3.4. Project Goal and Objectives

3.5. Project Activities

3.6. Monitoring and evaluation

3.7. Key Personnel

3.8. Project Partners

N/A

3.9. Strengths and Innovation

3.10. Sustainability

4. BUDGET:

4.1. Budget Summary

Total Requested:

$0.00

Project Total

$0.00

Note: Please submit a detailed budget in a spreadsheet format

4.2 Budget narrative

4.3 Miscellaneous

5. Certification:

By signing this application, I certify that the statements contained in this form are true, complete and accurate to the best of my knowledge.

I am aware that any false statements or claims may disqualify my organization from receiving this and any future awards.

|_| I agree

By marking the checkbox below I certify that I have read and understood the instructions provided with this form before filling out this document

|_| I have read the instructions provided with this form

Signature of Authorized Representative:

Date Signed:

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