PEPFAR Application of Interest_FY2024.docx

PEPFAR UGANDA COMMUNITY GRANTS TO COMBAT HIV/AIDS

FY2024 Application of Interest

Please provide DETAILED COMPLETE ANSWERS for the following question. Answers are limited to the space available in this form. DO NOT attach additional pages or revise this form in any way. DO NOT send printed, scanned or photographed versions of this form. Complete this Application of Interest electronically and return it to PEPFAR Uganda in its original Microsoft Word format.

Any changes to this form will be cause for an automatic rejection of this application.

PROJECT INFORMATION

Name of Organization*:

Project Title:

Project District: Project Sub-county:

Direct Project Beneficiaries (please check one): |_| Adolescent Girls and Young Women (AGYW) |_| Key Populations (KP) |_| Orphans and Vulnerable Children (OVC) |_| OVC & KP |_| Males and Young Men |_| People Living with HIV (PLHIV) |_| Persons with Disabilities (PWD) Number of Direct Beneficiaries Targeted: Number of Indirect Beneficiaries Targeted:

Please provide a description of your target beneficiary group(s) and how they will be selected:

*Only legally registered organizations with the Government of Uganda can apply.

ORGANIZATION INFORMATION

Organization Address:

P.O. Box Mailing Address (Required):

Organization Email Address:

Organization Phone Number: +256 Unique Entity ID (if applicable):

You do not need this registration before you apply, but if a grant is awarded, you will need a Unique Entity ID and valid registration on www.SAM.gov before the funds are disbursed.

APPLICANT CONTACT INFORMATION

*At least one contact person should be an official signatory of the organization.

Estimated Amount of Funding Requested in UGX:

Estimated Amount of Funding Requested in US Dollars:

An exchange rate of 3600UGX/$1 should be applied.

*Please ensure this amount matches the total in the detailed budget summary.*

PRIOR FUNDING

Please list all prior contributions to your organization, including funds provided by the Ugandan government.

ORGANIZATION SUMMARY

Please provide a brief background summary about your organization: (No more than 200 words.)

My organization's project addresses the following need(s) in my community:

· Community Need 1:

This is a community need because:

· Community Need 2:

This is a community need because:

· Community Need 3:

This is a community need because:

PROJECT GOALS AND OBJECTIVES

My organization’s project’s main goal is to:

My organization’s project will accomplish the following goals and objectives: (You do not have to include three objectives – this is the maximum number allowed for this proposal.) Please include a short list of the types of activities you will conduct that will accomplish each objective.

Objective 1:

Activities Summary:

HIV/AIDS-related services will be integrated into these activities in the following way(s):

Number of beneficiaries who will benefit: Number of sub-counties that will be reached:

Monitoring & Evaluation Plan for Objective One:

Objective 2:

Activities Summary:

HIV/AIDS-related services will be integrated into these activities in the following way(s):

Number of beneficiaries who will benefit: Number of sub-counties that will be reached:

Monitoring & Evaluation Plan for Objective Two:

Objective 3:

Activities Summary:

HIV/AIDS-related services will be integrated into these activities in the following way(s):

Number of beneficiaries who will benefit: Number of sub-counties that will be reached:

Monitoring & Evaluation Plan for Objective Three:

SUSTAINABILITY:

My organization’s project is sustainable. Beneficiaries will continue to receive benefits in the following way(s) after the grant has been completed. (No more than 200 words.)

INNOVATION

PEPFAR Uganda receives hundreds of applications each year for projects working to eradicate HIV/AIDS. Please describe why your project is unique, different, innovative and creative or somehow stands out from all the rest. (No more than 200 words.)

BUDGET

Please provide an overview of how your budget will be spent on this project. Please provide clarification on any budget items you do not think are clearly understood in the detailed budget summary. DO NOT LEAVE THIS SECTION BLANK

Please complete the excel worksheet to provide a detailed budget for all activities your organization is proposing. This detailed budget must be in Ugandan shillings and is to be submitted electronically with this Application of Interest. Only submit items in your budget that are allowable and that are absolutely essential to meeting your objectives.

ABBREVIATIONS AND ACRONYMS

Please provide a description/definition of all abbreviations or acronyms used in this proposal.

Before submitting check the following:

· |_| All fields are completed

· |_| My answers are clear (including spelling)

· |_| I have read the Notice of Funding and verify my proposal meets the PEPFAR Uganda requirements.

· |_| I have read the Notice of Funding and budget summary. My detailed budget only includes allowable expenses outlined by PEPFAR Uganda.

DUE DATE: July 31, 2023 by 11:59 PM (UTC +3) Applications can only be submitted via email. Send it to KampalaPEPFAR@state.gov.

Include the following in the email:

Organization name Project title

Required forms must be attached to the email (incomplete submissions will not be reviewed):

· PEPFAR Uganda Application of Interest_FY2022

· PEPFAR Uganda Budget Summary_FY2022

· SF-424, SF-242A, SF-424B

· Copy of the organization’s registration certificate, if available

DO NOT SEND:

· Bank details

· Photos

· Letters of recommendation

· Any additional attachments not requested by the program

If your project is selected to move to Round Two you will be required to provide additional information at that time.

The review process will take several months. Please do not contact the program for proposal status updates. We will contact you if you are selected to move to Round Two. Applicants not selected will be notified once all proposals have been reviewed.

United States Mission to Uganda – PEPFAR Uganda Community Grants Application of Interest May 2023 image1.png