Small-Grants-Application.docx

U.S. Embassy Paramaribo Public Affairs Section

SMALL GRANT APPLICATION

A. Application Information

Date of this application:

Project title:

Project total cost from all sources (in U.S. dollars):

Amount requested from U.S. Embassy (in U.S. dollars):

Project duration and approximate start and end dates:

Name of Applicant or Organization Name:

If Organization, Name of Contact Person and Position in Organization:

Address:

Telephone:

Email:

If individual is applying, brief description of your experience and qualifications. (250 words max)

If organization applying, brief description of organization’s mission and relevant experience (250 words max):

If organization applying, please list DUNS Number:

Priority addressed by this proposal:

B. Proposal

Problem Statement: A clear, concise, and well-supported statement of the problem to be addressed and why the proposed project is needed. (300 words max.)

Proposal Summary and Goals: Short narrative that outlines the proposed project, including project objectives and anticipated impact. (750 words max.)

Project Activities and Schedule: Describe the project activities and how they will help achieve the objectives. Include a timeline with dates, times, and locations of potential events and activities. How will this project be accessible to all people? (750 words max.)

Project Monitoring and Evaluation Plan: How will the activities be evaluated to make sure it is meeting the goals of the grant and how will the long-term impact of the project be measured. (300 words max.)

Future Funding or Sustainability: This section explains the applicant’s plan for continuing the project beyond the grant period, and/or the availability of other resources, if applicable. (250 words max.)

Project Partners: List any partners (individuals or organizations) with whom you will work to support or implement your project. Please note if you have an existing relationship with your partners and describe their role in the project. If you do not yet have an existing relationship, how do you anticipate establishing a partnership? (250 words max.)

Communication and Outreach Plan: How will you promote your project? Include social media, websites, print news, or other forms of media you intend to use to share information about your project to beneficiaries and the public. (250 words max.)

C. Budget Please submit your overall budget using the form below. You must also submit a more detailed budget using the Excel template. Please see the definitions of spending categories below

Personnel

Travel

Equipment

Supplies

Contractual

Other Direct Costs

Totals

Personnel: Describe the wages, salaries, and benefits of temporary or permanent staff who will be working directly for the applicant on the program, and the percentage of their time that will be spent on the program.

Travel: Estimate the costs of travel and per diem for this program. If the program involves international travel, include a brief statement of justification for that travel.

Equipment: Describe any machinery, furniture, or other personal property that is required for the program, which has a useful life of more than one year (or a life longer than the duration of the program), and costs at least $5,000 per unit.

Supplies: List and describe all the items and materials, including any computer devices, that are needed for the program. If an item costs more than $5,000 per unit, then put it in the budget under Equipment.

Contractual: Describe goods and services that the applicant plans to acquire through a contract with a vendor. Also describe any sub-awards to non-profit partners that will help carry out the program activities.

Other Direct Costs: Describe other costs directly associated with the program, which do not fit in the other categories. For example, shipping costs for materials and equipment or applicable taxes. All “Other” or “Miscellaneous” expenses must be itemized and explained.

“Cost Sharing” refers to contributions from the organization or other entities other than the U.S. Embassy. It also includes in-kind contributions such as volunteers’ time and donated venues.

Please explain any budget request that you think is not obvious:

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