Project Submission Form

Instructions:

Please respond to the following questions on a separate sheet (include question number with the response). Provide detailed information wherever possible. Please include any photographs of the project area, if available.

First Contact

About your Orgamization:
A1. Name of Organization.
A2. Are you a registered organization (trust, NGO) or group of individuals?
A3. Do you have FCRA (Foreign Contribution Regulation Act) clearance? If so, please provide us with the FCRA clearance number.
A4. Date of Establishment.
A5. Names and Background of decision making body within the organization.
A6. Name of Contact Person.
A7. Address.
A8. Phone Number/Fax.
A9. Objectives of the Organization.
A10. Affiliations.
A11. Size (staff/volunteers).
A12. Brief descriptions of previous projects (include funding source and amounts).
A13. References (if any).
A14. Brief description of the current project- It should include following points.

• Target population
• Location
• The complete amount of the project

Please answer Yes or No to the following questions:

• Does your organization have religious or communal inclination/backing?
• Does any of the previous projects have had scope for human or animal rights violation?
• Does your NGO have any conflict with the govt. rules?
• Does any of the previous projects have had any adverse impact on the environment?

Second Contact

Note: Please include annual report and budget, if possible and also other documents/newspaper cuttings related to the organization.

About your Project area:
B1. Name, address and phone number (if any) of Contact Person at project site.
B2. Location (include distance in kilometers to nearest district headquarters).
B3. Size of Project Area (include number of villages, population, area).
B4. Existing Health facilities (include information about nearest doctor/hospital).
B5. Existing Educational facilities (number of schools).
B6. Existing drinking water and electricity facilities.
B7. Primary occupation, income source and average annual income of people in the project area.

About the Project:
B8. Short term objectives of the project (1-2 years).
B9. Long term objectives of the project (3-5 years).
B10. Details of the planned operation of the project (project coordinator, number of staff members, how you plan to achieve the objective, methodology of implementation).
B11. What is the source of your motivation to be involved in the project?
B12. Funds required. Duration for which the funds are required.
B13. Itemized description of proposed use of funds (please provide a budget).
B14. Other sources of funds for the project.
B15. Other organizations which have been approached with the same project proposal.
B16. Name, experience and education of the Project Director/Coordinator and others involved in the project from your organization.