Assisi Development Foundation PERI-URBAN DEVELOPMENT PROGRAM APPLICATION FORMAT In preparing a project proposal, applicant organizations are requested to follow the format given below in answering all the items. The ADF Grant Committee will evaluate proposals in compliance with this format. Name of Organization: Name of Organization’s Chairperson / Chief Executive Officer: Organization’s Address / Telephone / Fax No. / E-mail Address: Name of Staff in Charge of the Project Proposal: Title: Name and Signature of the Organization’s CEO: Date of Submission: I. Identifying Information 1) Project Title: 2) Project Site: 3) Nature of the Project (Please check appropriate item/s): New On-going Part of a Larger Program 4) Total Project Cost: 5) Amount of Requested Grant from ADF: 6) Local Counterpart: 7) Project Duration: 8) Name of Officer-In-Charge of the Proposed Project and his/her Title: (Please attach his/her profile and information on past achievements.) 9) Number of Expected Beneficiaries: (Example: 200 children in 3 villages) II. Rationale 1) What is the present situation in the community where the proposed project is focused? What change has taken place in the community since the beginning of the project implementation? 2) What are the needs/problems? 3) Relevance of the proposed project in responding to these needs/problems: III. Details of the Project 1) Objectives a. Long-term (5-10 years) Objectives b. Short-term (1-4 years) Objectives 2) Design of the Project Please use the Project Design Matrix (PDM) provided at the end of this application form. You might describe the outline of the proposed project in your style if you find difficult to use PDM, but please make sure to cover the instruction/indicators given in the Matrix. ADF Peri-Urban Development Program FY2011
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3) Diagram of the Project Organizational Structure (Please show a diagram) 4) Time Schedule (one-year and multiple-year span) 5) Sustainability: Possibility to continue the project after the completion of the grant period of ADF. (Please explain how the beneficiaries can maintain financial sustainability after the project completion). 6) If the proposed project constitutes a portion of a larger program, please provide information on its origin, past achievements and financial resources. IV. Budget of the Proposed Project Refer to the chart below in the preparation of the project budget. If you plan to have other financial support for the project, (such as an applicant’s own income, contributions from community, other donors, etc.) please indicate their names separately. If available, please use the Microsoft Excel program Project Budget Form BUDGET ITEM
BREAKDOWN TOTAL PROJECT COST
AMOUNT REQUESTED
LOCAL COUNTERPART
FROM ADF
A. Project Direct Cost 1) 2) Sub Total B. Administrative Cost 1) 2) Sub Total TOTAL
V. Organizational Information Please provide information on the following: 1. Organizational Chart 2. Governing Body: (Ex. Board of Directors or related entities, list of members with their respective designation)
ADF Peri-Urban Development Program FY2011
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Reference
PROJECT DESIGN MATRIX Project Title: Target Area and Target beneficiaries: Narrative Summary Overall Goal of the Project:
Objectively Verifiable Indicators
Means of Verification
Important Assumptions
Project Purpose: Outputs (of the former year(s) if the project is ongoing): Expected Outputs (of this year activities): Activities: 1.
Input:
2. 3.
Pre-Conditions:
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