- Your organisation’s name:
2. Website and/or social media address:(i.e. Facebook, Twitter):
3. Primary Point of Contact:
Name:
Position:
Email:
Tel:
4. In what year was your organisation established? (YYYY)
5. Fiscal and regulatory authority registration
National registration authority / Registration number / Date of first registration (dd/month/yyyy) / Expiryof current registration
(dd/month/yyyy) / Registration attached to this form? (Yes/No)
6. Mission
Please state your organisation’s established or official mission:
(100 words max)
7. a. Strategy
Does your organisation have a strategic plan? (Yes/No)
If so, which years does your current or most recent strategic plan cover? (yyyy-yyyy)
7.b. What are the main areas of specific expertise for which your organisation is best recognised? (200 words max)
8. Board and Senior Management In Annex A, please provide a full list of your organisation’s Board and Senior Management Members (including the details of your Point of Contact listed above).
9. a. Please state the number of managers, employees, volunteers and consultants, by department, who work in your organisation’s headquarters. (in full-time equivalents - FTEs). Please state the location (town/city) of your headquarters in the first column.
Location / Staff type (FTEs) / Programmes & projects / Monitoring & evaluation / Finance / Fundraising/ communications / HR/admin
Managers
Employees
Volunteers
Consultants
9. b.Please state the number of managers, employees, volunteers, and consultants, by department, who work in your organisation in any other locations (such as field or regional offices), (in full-time equivalents - FTEs). Please specify clearly in each case the location (town/city). If you need additional locations please copy and paste the table.
Location / Staff type (FTEs) / Programmes & projects / Monitoring & evaluation / Finance / Fundraising/ communications / HR/admin
Managers
Employees
Volunteers
Consultants
10. a. Project Experience. Please list in Annex B,all relevant projects that your organisation has been directly involved with during the past 36 months either as an independent organisation or as a Consortium leader or Consortium member.
10. b. In addition to the projects listed in Annex B, please identify the presence, if any, of your organisation in other geographic locations (if any) identified in the Call. (200 words max)
Geographic location / Type of presence / Year established
Level 1. District / Level 2. Municipality / Head Quarters / Partner’s office / Field office / YYYY
10. c.In addition to the projects listed in Annex B, please identify other forms of engagement that you have had,whether directly or indirectly,over the past 36 months, with specificpopulation groups in the geographic area(s) identified in the Call.(200 words max)
Population group and
location / Description of engagement—please state whether it was direct or indirect (100 words max) / Start date (dd/month/yyyy) / End date (dd/month/yyyy)
11.a.Do you have written policy or guidelines covering (100 words per stage max)
Yes/No / Date of last update / Comments
Needs identification and analysis
Project design & planning
Project preparation
Project implementation
Project monitoring & evaluation
Project impact assessment and reporting
11. b. Please describe the methodologies and approach followed by your organisation at each stage of the project cycle (100 words per stage max)
Needs identification and analysis
Project design & planning
Project preparation
Project implementation
Project monitoring & evaluation
Project impact assessment and reporting
12. a. Please fill in the following table using local currency values:
Item/Period / Period 1:Current fiscal year / Period 2:
Previous fiscal year / Period 3:
Previous fiscal year
Budgeted expenses / Actual expenses / Actual expenses
Total amount
Current fiscal year (budget) / Previous fiscal year / Previous fiscal year
Value of expenses funded by donor grants
Name of largest donor for the period
Name of second largest donor for the period
Name of third largest donor
Value of expenses funded by own/unrestricted grants
Current fiscal year (budget) / Previous fiscal year / Previous fiscal year
Disbursements made to grantees and sub-grantees
12.b. Statutory audits: Please provide copies of your last two statutory audit reports
Period covered (DD/Month/YYYY) / Name of audit firm. Please specify any international affiliation the audit firm may have. / Audit opinion / Are any audit recommendations still open? If yes, when will you fully implement them?12.c. Please list any other audit or financial review your organisation has been subject to in 2015–2016
Type of review (audit, financial review, verification) / Name of donor or the government entity that required the review / Scope of review(e.g. project XYZ, $5m budget) / Are any recommendations still open? If yes, when will you fully implement them?12.d. Please provide details of your use of accounting software:
What is the name of the accounting software you use?Do you use it to prepare financial statements (Y/N)?
Do you use it to prepare budget monitoring reports? (Y/N)
Do you use it to prepare donor reports? (Y/N)
12. e. Policy framework. Do you have written policy or guidelines covering:
Yes/No / Date of last update / CommentsFinance
Accounting
Budgeting
Treasury management
Human Resources
Recruitment
Compensation management
Benefits
Performance management
Procurement of goods and services
Travel and Transport
Fraud/misappropriation/misuse/conflicts of interest
12. f. Financial management of Sub-Recipients
Who prepares it? / Who reviews it? / Who approves it? / CommentsSub-grant Budget
Disbursement request received from sub-grantees
Expenses report received from sub-grantees
13. a. Policy framework. Do you have written policy or guidelines covering:
Yes/No / Date of last update / CommentsIdentification and selection of Sub-Recipients
Oversight and support of programme implementation by Sub-Recipients
Operational management of Sub-Recipients
Financial management of Sub-Recipients
Capacity assessment and development of Sub-Recipients
13. b. Please describe the process and criteria you will use to identify and select Sub-Recipients for your consortium.(200 words max)
13.c.Please explain how you ensure that Sub-Recipients manage funds in compliance with your requirements: What do you do, who is involved, when does it happen? (250 words max)
13.d. Please describe how you will manage programme implementation by Sub-Recipients in your consortium.(200 words max)
13.e. Please describe how will you identify and rectify capacity shortfallsof Sub-Recipients in your consortium.(200 words max)
14.a. In addition to the projects listed in Annex B, have any of your organisation’s community-level initiatives prevented violent extremism in the last 36 months? If so, please give details below.
Project Name / Description of the project—include specific examples of how the initiative prevented violent extremism. (100 words max) / Start date (dd/month/yyyy) / End date (dd/month/yyyy)
14. b. Why is the prevention of violent extremism a priority for your organisation?(200 words max)
14.c. Please explain how your organisation’s mission relates to GCERF’s funding priorities in Kosovo. (250 words max)
‘
Declarations in support of application for the role of Principal Recipient
15. Has your organisation previously applied to GCERF? (Y/N)If your organisation is selected as a Principal Recipient, you will be expected to form a Consortium of potential Sub-Recipients that meets the expectations of both a GCERF Consortium and Sub-Recipients. A Principal Recipient is responsible for coordinating the development of a Consortium Proposal. A Principal Recipient is expected to establish written agreements with each potential Sub-Recipient prior to the submission of a Consortium Proposal.
By signing this Expression of Interest you confirm:
- your organisation acknowledges and is able to accept the role of a Principal Recipient as described above;
- that the information provided is correct to the best of your knowledge;
- you have read and agree to comply with the terms described in the GCERF code of conduct.
Signed:
______
Name:
Position:
Organisation: / Date:______2017
Annex A
Board and senior management members –Please provide a full list of your organisation’s Board and senior management members (including your organisation’s designated Point of Contact)Family name / First name(s) / Male / female / Position in the organisation / Country of residence / Date of birth (DD/MM/YY) / Country of birth
1
No / Project name / Project Type / Geographic location / Population group focus (if any) / PVE Focus (Y/N) / Total budget (USD) / Start date / End date / Name(s) of Donor(s) / Consortium project? (Y/N) / If Yes, what was your role?Please describe the purpose and focus of the project in less than 150 words / Level 1. District / Level 2. Municipality / Lead consortium / Sub-Recipient
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Add rows as required
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Expression of Interest Form-KOSOVO June 2016.docx