Attachment_A-TG_Request_Form_2019.doc

TRAVEL/TRANSFER GRANT REQUEST FORM

NO. T-

(filled in by COR) Date:

Please check one: Travel Grant: FORMCHECKBOX Transfer Grant: FORMCHECKBOX

Section I: (IAF staff requesting the grant must fill out form & submit electronically Managing Director, Learning and Impact; COR; ACOR

TOTAL AMOUNT REQUESTED: $

Travel Insurance (Please check one): Yes: FORMCHECKBOX No: FORMCHECKBOX

Name of traveler(s) as it appears on passport or Name of Organization: (Nombre del viajero como se lee en el pasaporte o Nombre de la Organización) Contact information (complete name, title, address, phone numbers, e-mail): (Información de contacto: Nombre completo, titulo, dirección, teléfono, y e-mail)

Passport (Country/País):

Traveler has required documentation to travel internationally (visa) (La persona viajando tiene la visa para el país que visita):

Objective of travel- Please write 3 or 4 lines explaining why this travel is important (objetivo del viaje):

Strategic Initiative (SI):

Target Group:

FORMCHECKBOX

Sustainable smallholder agriculture

Indigenous, approx. # ___

FORMCHECKBOX

Community-focused resource mobilization

FORMCHECKBOX

Women, approx. # ___

Social and economic inclusion

Youth, approx. # ___

Other

Afro-descendants, approx. # ___

LGBTI, approx. # ___

PwD, approx. # ___ Please explain selection of SI:

Description of activities- explain (descripción de actividades):

How will you share lessons learned with others? (¿Cómo compartirán lo que han aprendido con los demás?):

Referred by (IAF Staff member-please include your phone and e-mail address):

TRAVEL REQUIREMENTS: (please remove if requesting a TRANSFER grant)

Airfare, approx. $ = __________

Hotel, approx. $ = __________

Other transport, approx. $ = __________

Conf. Registration, approx. $ = __________

Per Diem transfer, approx. $ = __________

Total amount being requested (total de pedido): $__________ Transfer $________ (XXX %) *via: Bank Transfer FORMCHECKBOX or Wire Transfer FORMCHECKBOX

* You have the option of retaining 10% of the travel funds until receipt of the final report. Please refer to tips section in Guidelines for Funding Travel. Remaining 10% to be transferred upon completion of grant activities and receipt of the grantee’s supporting documentation and FINAL report, to be sent to requestor at the IAF no more than 3 weeks after trip. (Please remove if not applicable) Departing and arrival cities (Ciudades de salida y llegada):

Time frame (Fechas del viaje):

Number of travelers (número de viajeros):

Name of the Event (Nombre del Evento):

Attach conference/workshop/training registration information and any fees or costs, besides actual travel expenses:

Budget Detail (detalle presupuestaria):

Line items are examples (sub-líneas son ejemplos)

* Counterpart is a REQUIREMENT and only under exceptional circumstances can it be waived.

Contributions

Per Diem

Airfare

Facilitation

Transportation (taxis, etc.)

Passport Fees

Translation

Other (please specify)

TOTAL

Approval by direct supervisor and Managing Director, Learning and Impact:

(name, phone, e-mail address):

COR/ACOR Clearance:

(signature/date)