CN Template for Single and Multi-Year Submissions (Nov2021).docx

NGO Name

Project Title:

Lead Applicant Organization (if consortium, please include partners):

Primary Applicant Contact (Name, Title, e-mail address):

Country (countries) of Proposed Activities:

Indirect:

(Of the direct beneficiaries) Refugees:

Non-refugees:

Proposed Activity Sector/modalities(s) (please delete those that don’t apply):

· Capacity Building

· Capacity Building: NGO/CBO

· Capacity Building: Local Governments

· Cash and Voucher Assistance (CVA)

· Core Relief Items

· Inclusion of Persons with Disabilities

· Education

· Food Security

· Health

· Health: Reproductive Health

· Livelihoods And Economic Empowerment

· Mental Health and Psychosocial Support (MHPSS)

· Nutrition

· Protection

· Protection: Legal

· Protection: Child Protection

· Protection: GBV

· Shelter

· Socio-cultural Inclusion And Social Cohesion

· Water, Sanitation, Hygiene (WASH)

Single or Multi-year Program (if multi-year indicate number of years proposed):

Consortia (Y/N) if yes, see Section 6:

Total PRM Funding Requested:

Instructions and Information:

For full instructions and other required documents, refer to the relevant NOFO for this concept note and PRM’s NGO Guidelines at: https://www.state.gov/funding-opportunities/general-ngo-guidelines/

Concept note narratives must not exceed 4 pages (or 5 pages for consortia applications) in length using this template using Times New Roman, 12-point font, on letter-sized paper, with one-inch margins on all sides. The table on page 1 serves as a cover page and counts toward the total page limit. You may delete these instructions and those under each section header (italicized text only) for additional space. Do not include any additional cover page except for the table above. Page limits are strictly adhered to, and may result in disqualification. PRM strongly recommends that applicants submit concept notes in Adobe PDF format, as Microsoft Word page lengths may change under certain settings and could look different to PRM reviewers or extend documents beyond the page limit. Additionally, all documents and attachments must be submitted in English.

1. Brief problem statement, description of target population with anticipated beneficiary numbers and percentage breakdown of populations and vulnerability criteria used to identify beneficiaries:

Briefly describe the current or anticipated needs that this program seeks to address. Provide specific evidence based on assessments, including any protection risk and gender analyses, that have been conducted and other relevant background information collected to identify the needs of the target population, including dates and sources of information.

Describe the anticipated beneficiary population for this program including the process of beneficiary targeting and selection; how refugees, returnees, host community members will be identified; and what actions you would take to ensure that potentially vulnerable and underserved groups are included. Clearly demonstrate that refugees, returnees, and/or other persons of concern as described in the relevant NOFO will constitute a minimum of 50 percent of the beneficiary population. Using the most recent data available and citing sources, provide the anticipated demographic profile of the beneficiaries including the numbers of refugees, IDPs, returnees, host country nationals, etc., as well as locations, gender, age, and any other unique factors or vulnerabilities.

2. Program description, duration, and location:

Provide a description of the program including key activities, implementation plan, and any implementing partners, including their role in the program. Explain the strengths of this proposed program and how this program responds to the needs identified and the targeted beneficiaries and expected outcomes. Identify goods or services to be provided. Provide assessment and analysis of how the proposed program will uphold Sphere Protection Principles and mitigate potential protection risks as a result of proposed activities. If the standards differ from Sphere’s Core Humanitarian Standards, provide a justification for the variance.

Explain why multi-year funding is necessary for this program to succeed, and how the proposed activities in year one will contribute to outcomes and impacts in years two and/or three.

List the specific locations – including the names of camps, provinces, districts, villages, neighborhoods, temporary accommodation centers, etc. – of proposed activities. Provide GPS coordinates, where available and appropriate. If the locations are not yet known, explain how the sites would be chosen.

3. Proposed outcomes and impact of the program:

Provide a description of the program’s proposed outcomes and impact. Outcomes and impacts are defined as a result or effect that is caused by or attributable to the program, program or policy of the program activities. Outcomes may be short-term or long-term, intended or unintended, positive or negative, direct or indirect. Impact is often used to refer to higher level effects of a program that occur in the medium or long-term and can be intended or unintended and positive or negative.

4. Summary of the organization(s) and experience doing similar work:

Describe the organization’s relevant experience working in the proposed location and sector(s).

5. Organizational structure:

Provide details on the organization’s management structure for the proposed program, including specific management plans.

6. Consortia concept notes only:

If the applicant is applying as a consortium, include a description of how the consortium will be organized and how lines of authority and decision-making will be managed across all team members and between the lead applicant and associate awardees.

Organizations must submit the following documents with their application:

Note: All documents must be in English.

1. Concept note that does not exceed the 4-page limit (or 5 pages if a consortia submission).

2. Budget summary, disaggregated by year and for every year of the proposed program period.

3. Signed completed SF-424, SF-424A, and SF-424 B. These documents do not count against the page limit.

· Note: Form SF-424B is required only for those applicants who have not registered in SAM.gov or recertified their registration in SAM.gov since February 2, 2019, and completed the online representations and certifications. The SF-424 family forms are available on grants.gov.