Template_Proposal_Annex A_.docx

Annex A Ambassador's Special Self-Help Program Application

Date:

Funding Source:

PEPFAR(for people living with or directly affected by HIV/AIDS) or SSH: ________

Name of Proposed Project:

Name of Organization:

Registration Number of Organization:

Bank Where Organization has Account:

Project Manager/ Contact Person(s):

Project Manager ID Number:

Office Number:

Mobile Number(s):

Email:

Physical Mailing Address:

Location of Proposed Project Activities (include province):

1. Short Introduction to Organization

a. What is the purpose and overall mission statement of the organization?

b. How many staff does your organization have? How many will coordinate/manage this project?

c. Have you received and previous grants from the U. S. Government or other entities?

· Which entity issued the grant(s)?

· What are the project results today?

2. Proposal Summary

a. Why it is the project important?

b. How many people will benefit? List expected direct beneficiaries and indirect beneficiaries.

· Distinguish how many male vs. female beneficiaries.

· How did you select them?

c. Why do you require financial support and how will this advance the project?

3. Program Design This is the most important part of the proposal and should be 2-4 paragraphs.

This will also figure into your Project Evaluation Plan and Activities Timeline below.

a. How did your organization decide on this activity design?

b. What are the specific activities?

c. Who will be responsible for each activity?

d. Who is the project manager overseeing the project and activities?

e. Who will manage income generated from this project during and after the grant period?

f. How will you ensure that you achieve set milestones?

g. Does your project require the use of land? If so, provide proof of ownership/permission.

4. Project Objectives (Milestones) / Evaluation Framework

a. What are the objectives of this project?

b. What are the desired end results?

c. Fill in chart below. You can add or subtract rows as required.

· You should have 2-5 objectives. Each objective should have activities, a baseline, and a target directly linked to the objective. Examples in table will give you an idea. Be sure to create your own.

Objective: What is your overall milestones and goals?

Example: 1. raise household income for disadvantaged families in the rural area.

Activities: What specific activity will you do to reach your objective?

Example: 1.a. train community members on marketable produce 1.b. link community members to markets to sell produce.

Baseline: Measurable numbers collected before the start of this proposed project.

Example: 1. current average household monthly income is $50 Target: Measurable numbers expected after completing the project after one year.

Example: 1. increase in monthly household income to $100 for 90% of beneficiaries.

5. Activity Timeline

· Fill in boxes below with exact project activities/tasks in chronological order. (ie: hold stakeholders meeting, establish constitution, procure seed inputs, ect.)

· The exact month will depend when the grant is signed. For now, leave as Month 1-12.

· The only activities in the Month 1 should be sign grant agreement and request transfer of funds.

Activity:

x

Activity:

Activity:

x

Activity:

x

Activity:

x

Activity:

x

Activity:

x

Activity:

Activity:

x

Submit closeout reports x

6. Sustainability Plan

a. How will this project be self-sustaining?

b. How will you continue the project after the 12-month grant period is finished?

c. How will you build on this grant activity to continue improving your community?

7. Budget narrative explaining costs (Budget template in Annex B)

a. How much are you requesting?

b. How did you determine these costs?

c. Did you receive quotations from multiple suppliers? We require three quotes. How did you select the suppliers?

d. How will the community contribute to the project (labor, inputs, venue, equipment, money)?

e. What is the value of the community contributions?

f. How will you pay to maintain any equipment purchased through this grant?

Budget Template

Complete separate Annex B with detailed budget information.

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