PD Small Grants Mandatory Application Form.docx

U.S. Embassy Grants Program

SUGGESTED APPLICATION FORMAT

1. GENERAL INFORMATION:

1.1. Applicant Organization

a. Organization Name (English):

b. Organization Name (Original):

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

f. Website: g. Tax Code:

h. SAMS number: i. DUNS number:

For further information about SAMS/DUNS numbers, please check Embassy Rangoon’s Annual Program Statement at: Website

1.2. Authorized Representative (the person legally authorized to submit this application on behalf of the organization)

a. Last Name: b. First Name:

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

1.3. Application Tracking Information

a. Date on which you submitted this application: b. Are you submitting this application in response to a notice of funding opportunity (yes/no): c. If so, please give the funding opportunity number:

2. BACKGROUND OF ORGANIZATION:

2.1. Description

(Give a brief overview of your organization's primary work, goals, and objectives.)

2.2. Past Grants (U.S. Embassy)

(List the title, year, and dollar amount of past U.S. Embassy grants.)

2.3. Past Grants (Other)

(List the title, grant source, year, and dollar amount of grants received in the last five years from other organizations, if the project funded was similar to or related to the project proposed in this application.)

Last Updated: 12/05/2019 Page 3 of 4SENSITIVE BUT UNCLASSIFIED

3. PROJECT DESCRIPTION:

3.1. Project information

a. Project Name: (Give a short descriptive title to your project.)

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

c. Amount of Federal Funds Requested in U.S. Dollars:

3.2. Executive summary (English):

Give a short description of the goals of your project addressing the following: 1- What is the priority program area?

2-Who is the target audience 3-What is the American component 5-What are the activities and goals.

This should be no longer than 5 sentences. After reviewing this section, the reader should understand generally what you propose to do and why.

3.3. Project Context:

(Give an overview of the problem or issue you hope to address.)

3.4. Project Goal and Objectives

Describe what you want your community or sphere of influence to look like as a result of your project. Discuss both short-term (within the next year) and long-term (five years and beyond) goals and objectives.)

3.5. Project Audiences

(Briefly describe your key audiences for the project, both primary and secondary. Primary audiences are those who will participate directly in the program, while secondary audiences are those who will be reached by the project's primary audiences, as a result of their participation. Audiences are all individuals, organizations or groups outside of your own organization, not your organization's employees. Be sure to include approximately how many people will be reached by your project, including a breakdown of numbers of people reached in different project activities. For example, a teacher training program may reach 20 trainees (primary audience), but as these teachers implement what they have learned from the program, they could reach several hundred students (secondary audience).)

3.6. Project Activities

(Describe the tactics and activities you propose to use in order to achieve your goals and objectives, including each of the major steps you will need to take in order to carry out the activities successfully and a time line for each tactic/activity.)

3.7. Media Plan and Visibility (if choosing and safe to do so)

Your Organization’s Facebook/Twitter Page:

Your Organization’s Instagram Page:

Provide a description of your program’s media strategy, including the tools you’ll use. Please take into consideration any political sensitivities that may affect or compromise the program or the participants.

3.8. Monitoring and evaluation

(Describe how you will know whether your tactics and activities have actually achieved your goals and objectives. Include a description of how the program will be evaluated and by whom, keeping in mind that an external evaluation can be a valuable tool for planning and implementing similar future programs.)

3.9. Key Personnel

(Focus on employees of your organization with key roles on the project, giving names, titles, and how much time they will need to spend on the project in order to get the job done. Attach bios.)

3.10. Project Partners

3.11. Strengths and Innovation

(Tell us what makes your project particularly important, interesting, and likely to succeed.)

3.12. Sustainability

(Tell us how the results of your project will continue to multiply after the work plan is completed. In addition, tell us about the potential pitfalls of your strategy and your plan to overcome them. Bear in mind that PD Small Grants are generally meant to provide seed funds for pilot projects that have a likelihood of continuing to provide a positive impact after completion. These grants are generally not meant to become a significant annual contribution to on-going operational costs.)

4. MISCELLANEOUS:

(Tell us anything else that you think we really need to know about your application, that you have not been able to include elsewhere in this document.)

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