2015-2016Direct Aid Program (DAP) Application Form

A. PROJECT SUMMARY

PROJECT TITLE

Please provide a descriptive title

  1. NAME OF ORGANIZATION
  1. BRIEF DESCRIPTION OF YOUR ORGANIZATION

When was your organization started?

How many members do you have? (Total, women, men, youth)

What is the main purpose of your organization?

  1. ORGANISATION CONTACT DETAILS

Organization Contact / Name:
Postal Address:
Street Address:
Phone:
Email:
Fax:

4. PROJECT TIMELINE

Projects to be completed within one year.

How long will the project last?
Expected start date
Expected finish date

5. TYPE OF PROJECT

What type of project are your requesting funds for? Please circle. You can choose more than 1 category.

Minorities Disadvantaged Groups / Women
Health / Youth
Education / Community Development
Environment / Other (write in)

B. PROJECT DESCRIPTION

6. DESCRIBE THE COMMUNITY AND BENEFICIARIES WHERE THE PROJECT

WILL BE IMPLEMENTED.

  • Include relevant information about: population, livelihood, status of health, environment, education, distance from town or village.
  • Describe how the proposal was developed and who in the community was involved.
  • Describe how women, youth and community members will participate in the implementation and monitoring of the project.

7. WHAT IS THE PURPOSE OF THE PROJECT?

  • Describe the project
  • What will the project contribute to in your community?
  • What is the reason your project is needed in your community?
  • Clearly list the objectives of the project and explain how each one will be achieved?
  • Describe what will happen during the project and the main activities?
  • Training projects require an outline of the training program

8. HOW WILL YOU KNOW YOU’VE MET THE OBJECTIVES AND YOUR PROJECT

HAS MADE A POSITIVE IMPACT?

List the intended impact on the community, expected outcomes and outputs of the project. Include: the targetted total number of beneficiaries, including number of women, youth.

What is your monitoring and evaluation plan?

These must be measurable and referred to in all progress and final reports.

9. WHAT PLANS ARE IN PLACE TO SUSTAIN THE PROJECT ONCE DAP

PROJECT FUNDING HAS ENDED?

How will you meet maintenance, repair and operation costs in the future?

10. OTHER

Please include any other information you consider important

C. PROJECT APPLICANT

11. HAVE YOU RECEIVED FUNDING FROM THE AUSTRALIAN EMBASSY OR AUSTRALIAN AID (FORMERLY AUSAID) BEFORE?

Please list the project title, date of funding, and amount funded.

12. HAVE YOU MADE ANY OTHER APPLICATION FOR FUNDING FOR THIS

PROJECT?

Please provide details

13. HOW WILL YOU ENSURE THAT THE PROJECT IS PROPERLY BRANDED AS AN AUSTRALIAN GOVERNMENT FUNDED PROJECT?

Please list any potential plans such as media coverage and/or branding that will help increase the visibility of Australian Government’s support with this project.

14.DOES YOUR ORGANIZATION WORK WITH CHILDREN? IF YES, DO YOU

HAVE A CHILD PROECTION POLICY?

Projects that work with children must have a child protection policy.

D. PROJECT BUDGET

15. PLEASE LIST ITEMS, INCLUDING QUANTITY TO BE PURCHASED IN USD

NOTE: 3 quotes must be provided for all purchases of goods or services. Ongoing or recurrent costs are not funded.

ITEM

/

SPECIFICATIONS

/

QUANTITY

/

UNIT PRICE

/

TOTAL

TOTAL BUDGET EXPENDITURE:

E. FUNDING SOURCES

DAP: USD$______

Local contribution:USD$______

Other donors: USD$______

TOTALUSD$______

16. SIGNATURE

NAME:

ORGANIZATION:

POSITION:

DATE

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