Optional Template Eng.docx

Embassy of the United States of America Yaoundé, Cameroon

Small Grants Program B.P. 817 Yaoundé, Cameroon

The Climate Grants Program Application

The Climate Grants Program Application Form is FREE of charge and the Embassy DOES NOT require any payment to receive and evaluate a project. The use of this form is optional. If you chose not to use it, please ensure you provide all the information requested here, as indicated in the Notice of Funding Opportunity.

Funding Opportunity #: AFYDE-CLIMG-GR-POLECON-2024

Date: ______________________

1. ORGANIZATION’S INFORMATION (please provide copy of registration certificate and bylaws)

1.1 Organization’s Identity and Contact Information

Name of organization:

Organization’s UEI:

Address or P.O. Box:

Telephone:

E-mail (obligatory):

1.2 Organization’s Backup Contact Information (MANDATORY)

Title:

Address or P.O. Box:

Telephone:

E-mail (obligatory):

1.3 Description of Organization

When was your organization legalized? (attach paper)

How many members?

How often do you meet?

How are you organized?

What are your main activities?

Year:

Project title/type:

Project Site:

2. ORGANIZATION’S PAST EXPERIENCE

2.1 Previous projects carried out by the organization

Project 1 Title:

Type:

Main Donor:

Group’s contribution = Project total amount =

Year

Project 2 Title:

Type:

Main Donor:

Group’s contribution = Project total amount =

Year

Year of implementation:

2.2 Reference (cite 2 references that know your organization and its activities, but are not members or representative of your organization)

3. PROJECT INFORMATION

3.1 Executive Summary

3.2 Project Identification

Project Title:

3.3 Project Location

Village or Quarter:

Subdivision:

Division:

Region:

NB: Every project considered for funding will be visited before final approval. Please include location plan (sketch/directions) with your application specifying how to get to the project site or your office.

3.4 Project Description and Statement (Clear, concise and well-supported statement of the problem to be addressed and why the proposed program is needed.)

3.4.1 Number of Beneficiaries

Men__________ Women_____________ Boys ____________ Girls ____________ Total ___________

3.4.2 Project Background (describe the context of the project)

3.4.3 Project Justification (why is this project necessary?)

3.4.4 Project Objectives, Goals and Theory of Change

Project Overall Goal:

Project Specific Goals: Provide 2-3 specific objectives that include details on how the project will achieve the stated goal. Link back to the Program Objectives listed above. Describe how this project will meet emerging needs or fill a crucial gap left by other funding sources.

Theory of Change: Provide a short (1-2 sentence) statement that demonstrates a systemic change the project is trying to accomplish in the timeframe allotted.

3.4.5 Project Results (give results and state how they shall be measured)

Outputs:

Outcomes: What specific changes in events, occurrences, or conditions – such as attitudes, behaviors, knowledge, skills, status, or level of functioning – will be caused by or attributable to project activities?

3.4.6 Project Main Activities

3.4.7 Project Expected Impact (Describe the new situation that will arise from your project. Identify all performance indicators they will be employed.)

Impact:

Indicators: List indicators here (refer to the NOFO), and fill details in Performance Monitoring Plan in Annex 3

3.4.8 Project Performance Evaluation (Provide a brief description of how performance monitoring will be accomplished and outline the resources/capacity required to conduct these M&E activities. Include M&E plans activity-level output/outcome indicators)

3.4.9 Project Risks (Identify risk/assumptions and ways to address and mitigate them.)

3.4.10 Project Scope (How will it integrate with or leverage existing programs, local resources, and/or the activities of other donors to greater effect?)

3.4.11 Project Timeline (Explain how long it will take to complete the project and attach your plan of activities.)

3.5 Project Key personnel (Names, titles, roles and experience/qualifications of key personnel involved in the program. What proportion of their time will be used in support of this program?)

3.6 Project partners (List the names and type of involvement of key partner organizations and sub-awardees.)

3.7 Project Financial Summary

3.7.1 General financial details (Attach your project detailed budget or cost estimate to your application. For equipment purchase, include pro forma invoices from at least two different sources.)

What is the total cost of this project?

Used:

Who provided this money?

How much will your organization contribute again?

If yes, please provide details:

3.7.2 Embassy grant

How much money are you requesting from the United States Embassy?

FCFA:

Signature of Sponsor

4. Attachments

Attachment 1: Budget guidance and Template

Attachment 2: Budget Narrative

Attachment 3: Performance Monitoring Plan

Attachment 4: Project Logic Model

Attachment 5: Risk Analysis

Other:

Activities Timeline

Applicants may use the following sample activities timeline.

Phase I

Activity 2 and Activity 3

Phase II

Activity 4

Activity 5 and Activity 6

Activity 7 and Activity 8

Activity 9

X

Activity 4

X

Phase III

Activity 10

X

Activity 11

X

Evaluation and Final Reporting

X

CLIMG Application – Updated 2024 Page | 1 image1.wmf