2015 Whitley Award Application Form
This application form can only be completed with the help of the Guidance for Applicants Document. Guidance is available on all questions.
1. Name of Applicant
2. Country
3. Title of this application
4. Information on organisation/ initiative
Name of organisation:
Status (NGO, charity, non-profit, society, University etc):
- If not working through an NGO, please describe the context for project delivery:
Date organisation established:
Charity number:
Age of specific project for which applying:
5. Contact Details in full
Address:
Telephone (include international code):
Skype:
Email/s (indicate preferred):
Website/s:
Known periods when project leader will be unavailable:
6. Location of project/study site
i) Location(s) + brief description (please submit maps as separate attachments):
ii) Latitude: Longitude:
7. How did you hear about the Whitley Awards/ Whitley Fund for Nature?
How heard of Awards/WFN / Details / WhoDirect contact from WFN
Previous Whitley Award winner
Colleague
WFN Website
Non-WFN website
Other
8. Have you previously received funds from either:
The Whitley Fund for Nature (previously called the Whitley Laing Foundation)?
Yes No
Any grant from the Rufford Foundation or Rufford Small Grants (RSG) Foundation?
Yes No
§ If ‘Yes’ for either question
a. when did you receive funds?
b. type of Award/grant
c. how much were you awarded?
d. what was it for (name of project/ leader/ location)?
§ If you have an outstanding application with the Rufford or RSG Foundation, give details.
§ If this is not your first application for a Whitley Award, please give details of all previous applications.
9. Personal Summary - (no more than 500 words)
i) Nationality:
ii) Sex:
iii) Current job title/ position:
iv) Date of Birth AND Age:
v) Education:
vi) Languages:
vii) Previous related work and past awards and achievements:
viii) Experience as a team leader (use bullet points):
10. Executive summary - (100 words)
11. Your Work’s Objectives – (no more than 600 words total)
i) Issue(s) you are addressing:
ii) Aims and objectives (what do you want to achieve?):
iii) Project beneficiaries:
iv) Origin of project:
v) Evidence of success to date:
12. Activities and methodology
13. Proposal Logframe
OVERALL OBJECTIVE:Outcomes
(what is required to achieve the objective) / Outputs
(measurable results of the activities to be undertaken) / Activities and methodology
(including how progress will be monitored - note: not everything has to be monitored) / Risks / Assumptions
(and how you will overcome them)
14. Measuring impact/success
15. Timeline
Activity / MonthJun / Jul / Aug / Sep / Oct / Nov / Dec / Jan / Feb / Mar / Apr / May / Jun
16. Project need and urgency – (no more than 250 words)
17. Project Sustainability
18. Your Team members
Name / Age / Gender / Nationality / Role and employer / Qualifications/ Experience / Where based and Full/ Part time? (giving hours per week to be spent on proposed project)19. Collaborating organisations/ groups - Please indicate whether relationship is already active or proposed.
20. Dissemination of results
I confirm I have understood WFN aims to share, with my help, elements of the report from this Whitley Award grant with other members of the Whitley Award Alumni via the WFN website to facilitate the sharing of best practice in conservation.
Yes
21. Your Conservation Outlook - (no more than 350 words)
22. Photographs - These must be submitted as individual files separately to this form. Do not insert image files into the table below.
Photo number, your surname, photo name, date taken(to correspond with file name of the photograph you attach). / Photo caption (include subject and where taken)
Example
1_Smith_bushmeat_March11 / Example
Bushmeat confiscated from illegal hunters from Galmond National Park
1
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23. Footage and photos – Your ability to provide additional high quality footage, photographs and other media to WFN for the production of short films and publicity materials about you and your work
24. Summary Financial questions
ALL Projects run by NGO / Local Currency / GBP £ ConversionWhat was your NGO/organisation’s total income and expenditure last Financial Year (FY)? / Income:
Expenditure: / Income:
Expenditure:
Total of funding proposals currently pending for your NGO/organisation (across all programmes and for other purposes, including core costs):
This Specific Project / Local Currency / GBP £ Conversion
What was income and expenditure last Financial Year (FY) for this specific project (or previous related project if new)? / Income:
Expenditure: / Income:
Expenditure:
Total funding required for this specific project for next year (all donors):
Total funding already secured for this specific project for next year (all donors):
Total of funding proposals pending for this specific project:
Rate of exchange used & date: ______
25. Financial Information
A) Financial Governance
Please submit the following items separately along with your application unless indicated otherwise. Please do not embed scans of documents into this application form.
i) NGO/organisation Founding documents (e.g. constitution; registration certificate):
ii) Latest Audited Financial Statements/Accounts (or alternative, if not available):
iii) Explanation of Financial Controls of your NGO/organisation (provide a written summary below):
B) Project Budgeting
All budgets MUST be in £ GBP. Include rate of exchange used for conversions.
i) Historical Project Budget:
ii) Forecast Project Budget (must be inserted into document and NOT as a separate attachment):
iii) Explanation of Budget:
26. Your Fundraising
A) For the Project
In the table below, please state:
- Funding already secured for this specific project for next year (all donors)
- other funding applications for the project made within past 12 months which were declined
- Current or planned funding proposals with outcomes pending for this specific project
Name of funding body / Funding amount applied for (GBP £) / Date of proposal / Date of decision / Outcome (granted, pending or declined) / Grant start & end dates (and year)B) For the NGO / Organisation
In the table below, please state
- other current funding secured for your NGO/Org for next year not related to this project.
- other funding applications for your NGO/Org not related to this project made within past 12 months which were declined
- total of funding proposals for your NGO/Org not related to this specific project with outcomes pending
Name of Funding body / Funding amount applied for (GBP £) / Date of proposal / Date of decision / Outcome (granted, pending or declined) / Grant start & end dates (and year)C) List of all current major donors (more than £3,000 per year) for your NGO
27. Delivery of funds
28. Referee Statements
NAME / POSITION / ADDRESS / TELEPHONE / EMAIL (required)1.
2.
3.
29. Declaration from the Applicant
‘The information submitted in this application is true, to the best of my knowledge, information and belief. Should any significant developments arise after this application is made, I shall notify the WFN office immediately. I consent to the information contained in this application being held on computer and circulated to members of the Whitley Judging Panel, other interested parties and the media, under the terms of the Data Protection Act, 1984. I have requested the three referees named above to send their reference statements directly to the WFN office by the deadline and I understand that the opinions of referees and reviewers remain confidential to WFN and the Whitley Judging Panel and will not be disclosed to me, the applicant. I furthermore understand and give permission for the photographs I have sent in support of my application, and any further photos, video footage, music and any other visual and audio materials I later forward as part of my application, may be used to promote my work in the media, and other locations WFN deem appropriate, including in WFN publication materials and at the Whitley Awards Ceremony, and, should my application be successful, to promote the WFN as a donor to my work. I understand it is my responsibility to secure right of use over such materials before forwarding them to WFN and that I consent to their use by WFN as stated.
I understand that the Whitley Awards is an international competition and that the Judging Panel’s decision is final. I furthermore understand the Whitley Awards aim to fund and champion the work of dynamic conservation leaders who are effective communicators dedicated to spreading positive conservation learning and understanding globally. I understand what the Whitley Award is, a monetary grant to support the work outlined in this proposal, and a publicity prize applied for by conservationists who seek publicity for their work and who share the collaborative ethos outlined above.
Should I succeed in being shortlisted as a finalist, I will be invited to the U.K. for interview by the Judging Panel and to take part in a week of events in London in early/mid May. I understand that if I am selected as a finalist but am unable to come to interview in May this constitutes withdrawal from the competition. I understand that if I am selected as a finalist, I will be asked to provide video footage of my project work and further photographs to supplement my application, and that I will do everything I can to provide these materials quickly. I understand that if I win the Award the WFN team will assist me in publicising the work of my project and that, whilst publicity success is not guaranteed, I will do all that I can to assist WFN and will proactively take forward appropriate media opportunities. I confirm that to the best of my understanding and knowledge, winning the Whitley Award and attracting any associated publicity will benefit and do no harm to the conservation project or associated communities described in this proposal.’
Signature & Date ______
Whitley Fund for Nature
6 Walmer Courtyard, 225 Walmer Road, London, W11 4EY, U.K.
t: +44 (0)20 7221 9752 e: w: www.whitleyaward.org
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