NOFO_CARSI PANAMAFY25 - Templates for documents.pdf

U.S. DEPARTMENT OF STATE

Strengthening Government Through Civil Society Engagement in Panama

Notice of Funding Opportunity

Section H. OTHER INFORMATION

H1. Conflict of Interest

In accordance with applicable Federal awarding agency policy, applicants must disclose in writing any potential conflict of interest to the Federal awarding agency or pass-through entity.

H2. Applicant Vetting

N/A

H3. Marking Policy

Applicants are advised that recipients and sub-recipients of Federal assistance awards are subject to the State Department’s Marking Policy. More information on this policy can be found in Section N of the Department of State’s Standard Terms and Conditions:

https://www.state.gov/wp-content/uploads/2020/10/U.S.-Department-of-State-Standard- Terms-and-Conditions-10-21-2020-508.pdf

H4. Evaluation Policy

Applicants are advised that recipients and sub-recipients of Federal assistance awards are subject to the Department of State Evaluation Policy. More information on this policy can be found here: https://www.state.gov/guidance-for-the-design-monitoring-and-evaluation-policy-at-the-department-of-state/

H5. Monitoring Site Visits

A monitoring site visit, at least once during the lifetime of an award, may be conducted by Department of State personnel. The site visit is conducted to gather additional information on the recipient’s ability to properly implement the project, manage Department of State funds, and share substantiating document for programmatic and financial reporting. Specifically, the site visit may involve the review of the programmatic progress (progress on activities, sub-recipient/consultant work, etc.) as well as administrative and financial management controls.

This may include observing classroom modules virtually or in person and visit applicant’s headquarters and regional offices to observe operations.

H6. Privacy Disclosure https://www.state.gov/wp-content/uploads/2020/10/U.S.-Department-of-State-Standard-Terms-and-Conditions-10-21-2020-508.pdf https://www.state.gov/wp-content/uploads/2020/10/U.S.-Department-of-State-Standard-Terms-and-Conditions-10-21-2020-508.pdf https://www.state.gov/guidance-for-the-design-monitoring-and-evaluation-policy-at-the-department-of-state/ https://www.state.gov/guidance-for-the-design-monitoring-and-evaluation-policy-at-the-department-of-state/

Department of State understands that some information contained in applications may be considered sensitive or proprietary and will make appropriate efforts to protect such information. However, applicants are advised that Department of State cannot guarantee that such information will not be disclosed, including pursuant to the Freedom of Information Act (FOIA) or other similar statutes.

Mandatory disclosures (2 CFR 200.113)

Non-federal entity applicant or applicant for a federal award must disclose, in a timely manner, in writing to the federal awarding agency or pass-through entity all violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting the federal award. Non-federal entities that have received a Federal award including the terms and conditions outlined in Appendix XII of the 2 CFR 200—Award Terms and Conditions for Recipient Integrity and Performance Matters are required to report certain civil, criminal, or administrative proceedings to www.sam.gov.

Failure to make required disclosures can result in any of the remedies described in §200.338 Remedies for Noncompliance, including suspension or debarment.

The Department of State will issue an award to the Applicant whose application represents the best value to the U.S. Government based on technical merit, efficient use of U.S. Government funds, and satisfactory organizational capacity.

The Department of State reserves the right to make an award based on the initial application received with or without discussion or negotiations. Therefore, applications should contain the Applicants’ best terms from both cost and technical standpoints.

It is Department of State policy that English is the official language and U.S. dollar is the controlling currency. Applications and related supporting documents must be written in English and the accompanying budget must be presented in U.S. dollars.

DISCLAIMER:

The Department of State has no obligation to provide any additional future funding in connection with the award. Renewal of an award to increase or decrease funding or extend the period of performance is at the total discretion of the Department of State and availability of funding.

Attachments:

1. Budget Template for New Awards

2. Budget Guidelines

3. Proposal Submission Instructions (PSI)

3. Other: Tabs A through E http://www.sam.gov/

TAB A: PROPOSAL GUIDELINES

Proposals should include the following components:

• Introduction and Problem Statement

• Planned Activities

• Indicators

Problem Statement and Rationale: Describe the problem and how the project will achieve or contribute to achieving a sustainable solution and a measurable outcome. The applicant should explain the extent of existing assistance within the particular geographic area, and how the proposed intervention may complement (or differ from) other similar interventions. The applicant should also explain, as necessary, the particular experience and qualifications it brings to the project. The rationale should also reflect an understanding of the priorities and policies of U.S. Embassy Panama or project with which this proposal is associated.

Planned Activities and Indicators: Describe the planned activities, and relevant stakeholders for implementation. The applicant should highlight key stakeholders and their expected roles in the project, along with any contingencies. The applicant should list assumptions that are dependent upon the ultimate success of the project. This could include elements like geographic location, coordination efforts with other international organizations, or political will from host governments, private sector, and NGOs. As appropriate, limited contingency possibilities should be included in the proposal, in case the initial planning assumptions are not met. Example of a planned activity and contingency:

Sample Planned Ac�vity Con�ngency Government services workshops in collabora�on with the central Government of Costa Rica, focused on improving knowledge of protocols for delivery of a government service.

(Example: the equitable provision of public services.)

If the appropriate agency of the Government of Costa Rica does not engage at the expected level, project team will look to municipal or local governments to assist in convening key stakeholders.

In the proposal, there should be a clearly defined link between each of the following elements as delineated:

• Problem Statement

• Planned Activities/Inputs

• Process Indicators

• Output Indicators

• Outcome Indicators

• Impact

Process Indicators measure the activity that has been completed. Please delineate the specific activities to be conducted, such as workshops, roundtables, trainings, forums, exchanges, policy dialogues, etc. All indicators must include targets. Example of a process indicator:

Process Indicator 50 women trained in energy efficiency standards

Output Indicators, otherwise known as deliverables, associated with the agreement, should be included. Unlike process indicators, outputs are what is produced, and are often tangible. At this level, it is the measurement of ability, knowledge, skills, or access. All indicators must include targets. Example of an output indicator involving the same participants:

Output Indicator 80 percent of par�cipants demonstrate at least 75 percent cognizance of standards to effec�vely provide government services.

Output Indicator 50 government workers trained in protocols or standards for providing a par�cular government service

Outcome Indicators measure the change in system, behavior, or practice. Expected outcomes are the results that come from a series of activities that are necessary to achieve impact. All indicators must include targets. Example of an outcome indicator:

Outcome Indicator 30 percent of government services offered by the targeted agency(ies) begin to implement new protocols as a result of par�cipants’ par�cipa�on.

All indicators must include measurable, numerical targets, which should serve as the foundation for monitoring and evaluation efforts. Ultimately, proposed activities and achievement of indicator targets will lead to impact.

TAB B: PROJECT MONITORING PLAN (PMP)

U.S. Embassy Panama will work with recipient organizations to implement the appropriate monitoring plan that meets both the needs of U.S. Embassy Panama and the implementing partner. Incorporating a well-designed monitoring component into a project is one of the most efficient methods of documenting the progress and potential success of a project.

Proposals should include a methodology to survey beneficiaries before and after activities occur to measure quantitative and qualitative progress. Successful monitoring depends on the following:

• Setting objectives that are specific, measurable, attainable, results-focused, and placed in a reasonable time frame (SMART);

• Linking project activities to stated objectives;

• Defining the baseline data; and

• Developing key performance indicators that measure realistic progress towards the objectives.

Complete applications will include a detailed M&E Narrative and M&E Plan, which detail how the project’s progress will be monitored and evaluated. Incorporating well-designed monitoring and evaluation processes into a project is an efficient method for documenting the change (intended and unintended) that a project seeks. Applications should demonstrate the capacity to provide objectives with measurable outputs and outcomes.

U.S. Embassy Panama expects implementing organizations will track participants or partners as appropriate and be able to respond to key evaluation questions, including satisfaction with the project/training, information learned as a result of the project/training, changes in attitude and behavior as a result of the project, and effects of the project on institutions with which participants work or partner. Applicants should include the monitoring and evaluation process in their timeline.

The grantee will be required to provide reports with an analysis and summary of their findings, both quantitative and qualitative, in regular progress reports to U.S. Embassy Panama. The quality of the M&E sections will be judged on the narrative explaining how both monitoring and evaluation will be carried out and who will be responsible for those related activities. The M&E Narrative should explain how an external evaluation will be incorporated into the project implementation plan or how the project will be systematically assessed in the absence of one.

The monitoring plan should include, at a minimum, the following elements:

• A results “Logic Model” planning document (see sample on page 20).

• Indicators, as described in Tab A, as well as details on how each indicator will be measured, frequency of the measurements, units of measure, etc. Provide indicators at the output and outcome levels. Monitoring plans should include a chart component that clearly delineates indicators and targets. All indicators must include measurable, numerical targets.

• Establish, where possible, performance baseline data and expected performance targets for each indicator/outcome. In some cases, the baseline may be zero.

• Describe monitoring tools, such as rapid assessment surveys, site visits, key stakeholder interviews, etc., that will be used.

• Plans should describe how the project’s impact and effectiveness will be monitored throughout the project.

Sample Evaluation Plan

Activity: Training Course Indicator

Type Indicator Name Source Target

FY23 Q4

Results

FY23 Q4

Target

FY24 Q1

Results

FY24 Q1

Output # of government workers trained

Training records 10 20

Outcome

Improved level of support provided as a result of participants’ direct or indirect participation in training

Project reporting -+0

Activity: Government Roundtable Indicator

Type Indicator Name Source Target

FY23 Q4

Results

FY23 Q4

Target

FY24Q1

Results

FY24Q1

Output xxx Outcome yyy

Sample “Logic Model” Planning Tool

Note: Outcomes, outputs, and activities should include numerical, measurable targets. A Logic Model is a useful tool for planning and utilized when designing monitoring and evaluation methodology and frameworks.

Please note that particularly when the expected outcome or impact is “improved XXX,” it is critical to set a baseline and expected improvement. For example, in the chart above, Outcome 1 “Improved production and productivity of female and male producers” would need to define the production and productivity at the start of the project (or use some other baseline data), then define a percent increase desired.

Impact: Improved Efficiency of Identified Government Services for 50,000 households in Costa Rica

Outcome 1

Improved productivity of government workers in targeted agency(ies).

Outcome 2 Increased adoption of efficiency standards by

75% of targeted government workers

Output 1.1 Productivity

Targets Established

Output 1.2 Improved access to government services by citizens

Output 2.1

Efficiency Manual Established

Output 2.2 Improved knowledge of efficiency principles and practices

Activities Conduct productivity training

Identify government services providers for training

Develop and distribute productivity training materials

Conduct training for access to government services utilizing new phone application.

Develop a phone application for

Organize and hold workshops for affected citizens.

Train government workers on efficiency techniques for providing services

Distribute materials to designated government workers

Develop materials for training on efficiency

Train government workers on the principles of efficiency

Develop efficiency principles materials to use with government workers.

TAB C: BUDGET GUIDELINES

Complete budgets will provide a detailed line-item budget outlining specific cost requirements for proposed activities. A minimum of three columns should be used to delineate the Embassy funding request, cost share by applicant, and total project funding. Complete applications will include a budget narrative to clarify and justify individual line items (i.e., calculations of how the costs were derived per month or year, their necessity, and overall contribution to the project’s cost-effectiveness).

The three-column proposal line-item budget should include the following components, in the suggested format below:

Unit Cost

Requested Federal Funds

Cost Share by Applicant

Program Total

A. PERSONNEL

A.1 Personnel A.1.1 Program Manager

A.1.2 Project Officer

A.1.3 Accountant

Subtotal Personnel

B. FRINGE BENEFITS

B.1 Primarily Fringe Benefits B.1 Other Fringe Benefits Subtotal Fringe Benefits

C. TRAVEL

C.1 International Travel

C.1.1 Monitoring Travel C.1.2 Roundtrip Travel from X to Panama for X Forum

C.2 Travel within Panama C.2.1 Roundtrip Travel from X city/province to X city/province

C.2.2 Car rental for X days

C.2.3 Hotel nights for X traveler in X city

C.2.4 Activity 1: Workshop -Staff Travel (# staff) -Staff Per Diem (X days) C.2.4 Activity 1: Workshop -Participant Travel (# participants)

- Participant Per Diem (X days) Subtotal Travel

D. EQUIPMENT

Subtotal Equipment

E. SUPPLIES

E.1 Laptop computer E.2 Mobile phone E.3 Printer E.4 Markers and dry erase board

Subtotal Supplies

F. CONTRACTUAL

F.1 Subgrants F.1.1 Subgrant to X organization F.1.2 Subgrant to Y organization F.2 Subcontracts

F.2.1 Social media management specialist

F.2.2 Website design specialist

F.2.3 Graphic design specialist Subtotal Contractual

G. CONSTRUCTION

H. OTHER DIRECT COSTS

H.1 Advertising H.2 Subscriptions

H.3 Production of course curriculum

H.4 Venue Rental

H.5 Catering Subtotal Other

I. TOTAL DIRECT CHARGES

(Sum of A-H Subtotals)

J. INDIRECT CHARGES

a) Indirect Costs (10% De Minimus or NICRA (X% of eligible direct costs)) Subtotal Indirect Charges K. TOTAL COSTS (Sum I-J)

Note: This budget is designed to serve as an example of the format for complete budget submissions and is NOT exhaustive. Please utilize the attached template or download from Grants.gov. Individual line items included in each applicant’s budget should reflect specific project activities. (pax = participants)

LINE-ITEM BUDGET – (applicants are instructed to utilize the following Excel budget template, which includes an instruction sheet): https://www.state.gov/wp-content/uploads/2021/11/Budget-Guidance-for-Applicants-Multiple-Funding-Types- December-2021.xlsx

Before grants are awarded, U.S. Embassy Panama reserves the right to reduce, revise, or increase proposal budgets in accordance with the needs of U.S. Embassy Panama’s project and availability of funds.

As mentioned above, the detailed budget should also include an accompanying budget notes document that explains and justifies each line item, in the suggested format below:

Budget Justification Narrative

A. Personnel: Identify staffing requirements by each position title and brief description of duties. For clarity, please list the annual salary of each position, percentage of time and number of months devoted to the project. (e.g., Administrative Director: $30,000/year x 25% x

8.5 months; calculation: $30,000/12 = $2,500 x 25% x 8.5 months = $5,312.).

B. Fringe Benefits: State benefit costs separately from salary costs and explain how benefits are computed for each category of employee - specify type and rate.

C. Travel: Staff and any participant travel:

1) International airfare

2) In-country travel

3) Domestic travel in Country X., if any

4) Per diem/maintenance includes lodging, meals and incidentals for both participant and staff travel. Rates of maximum allowances for U.S. and foreign travel are available from the following website: https://www.gsa.gov/travel/plan-book/per-diem-rates. Per diem rates may not exceed the published U.S. government allowance rates; however, institutions may use per diem rates lower than official government rates.

5) Staff refers to grantee staff only, and not sub-grantee staff or contractors.

D. Equipment: Please provide justification for any equipment purchase/rental, defined as tangible personal property having a useful life of more than one year and an acquisition cost of $5000 or more.

E. Supplies: List items separately using unit costs (and the percentage of each unit cost being charged to the grant) for photocopying, postage, telephone/fax, printing, and office supplies (e.g., Telephone: $50/month x 50% = $25/month x 12 months).

F. Contractual

a) Sub-grants: For each sub-grant/contract, please provide a detailed line-item budget breakdown explaining specific services. Please provide a sub-grant budget using the approved OMB budget with the above budget format. (See Tab C: Budget Guidelines, above.)

b) Consultant Fees. For example, lecture fees, honoraria, travel, and per diem for outside speakers or independent evaluators: list number of people and rates per day (e.g., 2 x $150/day x 2 days).

G. Other Direct Costs: These will vary depending on the nature of the project. The inclusion of each should be justified in the budget narrative. All costs must be allowable, allocable, and reasonable, and consistent with OMB guidelines. Line items such as “Miscellaneous,” “Contingency Fund,” and “Reserve Fund” are permissible but must comply with the cost principles and include justification. Examples of allowable Other Direct Costs include but are not limited to catering, conference room rental, digital licenses, advertising and social media management fees. Allowable costs must also be justified, for example: advertising and social media management fees are justified if they amplify the reach of an activity associated to an indicator.

H. Indirect Charges: See 2 CFR 200.414, "Indirect Costs”

1) If your organization has an indirect cost-rate agreement (NICRA) with the U.S. government, please include a copy of this agreement. Please specify if your organization elects to charge the de minimis rate of 10% of the modified total direct costs (MTDC). This does not count against submission page limitations.

2) If your organization is charging an indirect rate, please indicate how the rate is applied to direct administrative expenses, to all direct costs, to wages and salaries only, etc.

3) Do not include indirect costs against participant expenses in the proposal budget, as the embassy generally will not pay for these costs.

https://www.gsa.gov/travel/plan-book/per-diem-rates

Direct Costs/Indirect Costs - Indirect costs are organizational or overhead costs; not tied directly to the grant project. Some examples of indirect costs include water, maintenance, electricity, or rent. These costs are covered through the application of the NICRA or the 10% de minimus to the modified total direct costs (MTDC). The MTDC is not a percentage of the total budget, but rather a percentage of the legally permissible line-items.

Per 2 CFR 200.68, Modified Total Direct Cost (MTDC) includes all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $25,000 of each subaward (regardless of the period of performance of the subawards under the award).

MTDC excludes overhead expenses, equipment (tangible non-expendable personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit), capital expenditures, rental costs, donated services, in-kind contributions, tuition remission, scholarships and fellowships, participant support costs and the portion of each subaward in excess of $25,000. The definition of MTDC in 2 CFR 200.68 no longer allows for any sub-contracts to be included in the calculation.

Cost Share/Cost Effectiveness: Cost sharing is not required. Explanation of contributions should be included, whether cash or in-kind. Assign a monetary value in U.S. dollars to each in-kind contribution. If the proposed project is a component of a larger program, identify other funding sources for the proposal and indicate the specific funding amount to be provided by those sources. In addition, it is recommended that budget narratives address the overall cost-effectiveness of the proposal, including leveraging of institutional or other resources. Cost sharing or matching refers to a portion of project or program cost that is not borne by the Federal government. Grantees must follow the cost sharing or matching policy as stipulated in 2 CFR 200.306. Cost-sharing amounts proposed will be incorporated as part of the allowable budget items. If selected for an award, the organization will have to provide the minimum amount of cost sharing as stipulated in the budget approved by an Embassy Grants Officer. If the organization does not meet its cost-share amount stipulated in the approved budget by the end of the period of performance, the Embassy will have the option to (1) reduce its contribution in proportion to the organization’s contribution in the event that it does not provide the minimum amount of cost sharing stipulated in the budget or (2) hold the organization accountable for the amount specified in the approved budget.

BUDGET CONDITIONS AND RESTRICTIONS

The Embassy does not pay for the following:

• Publication of materials for distribution within the United States

• Administration of a project that will make a profit

• Expenses incurred before or after the specified dates of award period of performance (unless prior written approval received)

• Projects designed to advocate policy views or positions of foreign governments or views of a particular political faction

• Alcoholic beverages

• Costs of entertainment, including amusement, diversion, and social activities and any associated costs are unallowable, except where specific costs that might otherwise be considered entertainment have a programmatic purpose and are authorized either in the approved budget for the Federal award or with prior written approval of the Federal awarding agency

• Purchase of land

• Construction

• Direct social support

• Support for police law enforcement officials or military forces

The Embassy may make conditions and recommendations on proposals to enhance proposed projects. Conditions and recommendations are to be addressed by the applicant before approval of the award. To ensure effective use of U.S. Embassy Panama funds, conditions or recommendations may include requests to increase, decrease, clarify, and/or justify costs.

TAB D: GUIDELINES FOR STANDARD FORMS

SF-424 – Complete all fields except fields noted as “Leave Blank” below.

Link to form: http://apply07.grants.gov/apply/forms/sample/SF424_2_1-V2.1.pdf

1. Type of Submission: Application

2. Type of Application: New

3. Date Received: Leave blank. This will automatically be assigned

4. Applicant Identifier: Leave blank 5a. Federal Entity Identifier: Leave blank 5b. Federal Award Identifier: Leave blank

6. Date Received by Embassy: Leave blank. This will automatically be assigned

7. State Application Identified: Leave blank. This will automatically be assigned 8a. Enter the legal name of the applicant organization.

8b. Employer/Taxpayer ID Number: N/A.

8c. Organizational UEI: Organizations can request a UEI number at SAM.gov 8d. Enter the full address of the applicant 8e. Enter the name of the primary organizational unit (and department or division, if applicable) that will undertake the assistance activity, if applicable 8f. Enter the name, title, organization, and contact information of person to be contacted on matters involving this application

9. Select an applicant type (type of organization)

10. Enter: U.S. Embassy Panama

11. Enter: N/A

12. Enter the Funding Opportunity Number and title. This number will already be entered on electronic applications.

13. Enter the Competition Identification Number and title. This number will already be entered on electronic applications.

14. Areas Affected by Project: List the country or countries where project activities will take place in alphabetical order.

15. Enter the title of the proposed project (if necessary, delete pre-printed wording) 16a. Enter congressional district of Applicant.

16b. Enter: 00 Program: Leave blank

17. Enter a start date of [insert date] and a projected end date 18a. Enter the amount requested for the project under “Federal” 18b. Enter any cost-share under “Applicant."

19. Enter “c”

20. Select the appropriate box. If you answer “yes” to this question you will be required to provide an explanation.

21. Enter the name, title, and contact information of the individual authorized to sign for the application.

http://apply07.grants.gov/apply/forms/sample/SF424_2_1-V2.1.pdf

SF-424A – Please review the detailed instructions below BEFORE completing this form online.

Link to form: http://apply07.grants.gov/apply/forms/sample/SF424A-V1.0.pdf

Section A - Budget Summary - Complete Row 1 1a. Enter: CARSI Program (This is the only grant program that needs to be Entered.)

1b. Enter: N/A 1c-d. Leave these fields blank.

1e. Enter the amount of Federal funds you are requesting for this project 1f. Enter the amount of any other funds you will receive towards this project 1g. Enter the total cost of this project

Rows 2, 3, and 4 should be left blank.

Section B - Budget Categories – Enter total project costs in each category in Column 1 as described below. In Column 5, the form should automatically show the sum. Columns 2, 3, and 4 should be left blank.

6a-h. Enter the amount for each object class category (Include cost share).

6i. Enter the sum of 6a-6h 6j. Enter any indirect charges 6k. Enter the sum of 6i and 6j

7. Enter any program income that will be earned as a result of the project. If there is none, leave this section blank.

Section C - Non-Federal Resources (Only complete this section if your project includes an applicant cost share or funds from other sources-cost share is not required) 8a. Under Grant Program enter: U.S. Embassy Panama 8b. Enter your cost share amount 8c. Enter the amount of any other funding sources for this project 8d. Leave blank 8e. Enter the total amount for all non-Federal resources (the form should automatically show this sum)

Rows 9, 10, and 11 should be left blank.

Section D - Forecasted Cash Needs

13. In the first column, enter the amount of Federal funds you expect to expend in the project’s first year. Forecasted cash needs by quarter are not required.

14. In the first column, enter the amount of non-Federal funds you expect to expend in the project’s first year. Forecasted cash needs by quarter are not required.

15. In the first column enter the sum of 13 and 14 (the form should automatically show this sum). Forecasted cash needs by quarter are not required.

Section E - Budget Estimates of Federal Funds Needed for Balance of the Project http://apply07.grants.gov/apply/forms/sample/SF424A-V1.0.pdf

16a. Under Grant Program enter: CARSI Program 16b. Enter the amount of Federal funds you expect to expend in year two of the project.

16c. Enter the amount of Federal funds you expect to expend in year three of the project.

16d. and 16e. Leave blank

Rows 17, 18, 19 should be left blank.

20. Enter the total amount for each year (The form should automatically show this sum).

Section F - Other Budget Information

21. Enter: Direct Charges – Leave Blank

22. Enter: Indirect Charges – If Indirect Charges are shown in Section B 6, enter the type of Indirect Rate used (Provisional, Predetermined, Final, or Fixed)

a. Enter any comments

TAB E: CARSI Economic Support Funds Project Proposal Cover Sheet

Country: Panama Project No. (To be assigned by U.S. Embassy)

Date of Submission: ________________

Project Title: ______________________________________________________

Name of Organization: ______________________________________________

Mailing Address: ___________________________________________________

Street Address: ____________________________________________________

Telephone: _____________________ Fax: ___________________________

Alternate Telephone: ________________ E-Mail: ________________________

Principal Officer: __________________________________ (name and position)

Project Contact: __________________________________ (name and position)

Proposed Project Duration (not more than two years): ____________________

FINANCES:

Total ESF Funds Requested __________ (US$) Total Cost Share (optional) __________ (US$) Total Project Cost __________ (US$)

The following items are required in your proposal:

____ Cover Sheet (This page filled in) ____ Completed and signed SF-424, SF-424a and SF424b, submitted to www.Grants.gov ____ Table of Contents ____ Executive Summary ____ Proposal Narrative ____ Budget Narrative ____ Detailed Line-Item Budget ____ Additional attachments: Organizational Capability; Project Monitoring Plan;

____ Resumes of Key Persons; Proof of Organization’s Legal Status; Letter of Support from https://grants.gov/

Approved: Embassy Panama City/EXEC – John Barrett, DCM

Drafted: POL: Lourdes Ayala, Embassy Panama City

Cleared:

WHA/PPC: LJilka (OK) WHA/PPC: TJeffrey (OK) WHA/PPC: CPereira (OK) WHA/CEN: LButler (OK) WHA/CEN: JYoule (OK) WHA/CEN: STaylor (OK) POL: Brian Williams (ok)

POL: Lourdes Ayala (OK)