World Bank
Grants Facility for Indigenous Peoples
Application Form
Contact Information
1. Name of the Indigenous Peoples’ community
2. Name of the organization that will manage the grant (organization must be legally registered with a bank account in the organization’s name)
3. Title of project
4. Name and title of the person in charge of project
5. Mailing address, including district, state, province, and postal code
6. Country where project will be implemented
7. Telephone, including country and city codes
8. Fax, including country and city codes
9. Email
10. Please provide details of legal registration (such as date, registration number, government agency, etc.
Community / Organization Information
11. Please describe the mission of the community or organization and how it relates to the project and people it serves.
12. Please describe the Indigenous Peoples that the community or organization serves, works with, or supports. What is the name of the Indigenous Peoples’ group?
13. Please describe 3 major accomplishments of the community or organization since it began, including a description of the funding source, outcomes, and cooperation with community organizations, NGOs, government agencies, donor organizations, or international institutions.
14. Please describe the relevant skills of the staff who will be implementing the proposed project.
15. Please describe the organizational structure of the community or organization, including the staffing and governance structure and the role of its Indigenous members, including women.
16. Please note any local, regional, national and global Indigenous Peoples’ organizations and networks with which the community or organization works and describe the relationship.
17. How much money in US dollars ($) does the organization plan to spend this year, including all projects and operating expenses. Please list the organization’s major sources of funding.
18. What internal controls are in place to govern the use of funds?
Project Information
19. What are the issues and problems that the project will address? Why are these issues critical to Indigenous Peoples’ communities?
20. How will the grant from the Grants Facility for Indigenous Peoples be used to address these issues? Please describe the activities to be funded by the grant within the one-year timeframe.
21. How will Indigenous Peoples be involved in the design, implementation, and evaluation of the project?
22. What are the anticipated results of the project? What changes will occur as a result of the project?
23. How will the implementation of the project be monitored and evaluated?
24. How will the project be sustained after the period of grant implementation?
Grant Request Information
25. Grants range from US $10,000 to US $30,000. What is the total amount in US dollars requested from the Grants Facility for Indigenous Peoples for the proposed project?
26. Please provide an itemized project budget in U.S. dollars and for a period of one year only.
BUDGET ITEMS(quantity and cost per unit) / Cost in U.S. $ / Amount Requested from World Bank Grants Facility / Other funding
(specify source of funding)
List items
TOTAL / US $ / US $ / US $ (should be minimum of 20% of total costs)
Checklist for applicants:
The organization submitting the proposal must meet the following eligibility criteria before applying and submitting the proposal:
Organization managing the grant is legally registered
Organization has a bank account in its name
Proposed project is designed and implemented by an Indigenous Peoples organization or community
Budget includes 20 percent match amount
Applications should be emailed to
by November 15, 2005.