APPLICATION FORM

“ADVOCACY EFFORTS FOR INSTITUTIONAL AND POLICY CHANGE PROGRAMME”

1. ADMINISTRATIVE INFORMATION

  1. Date of submission of application:

  1. Organisation name:

  1. Name and position of contact person:

  1. Province:

  1. Phone number:

  1. Fax number:

  1. Email:

  1. Physical address:

  1. Postal address (if different to the physical address):

  1. In no more than five sentences, what does your organisation do? For example, what type of organisation is it, what is your core business, and who are the people you serve?

  1. NPO number:

  1. When was the organisation established?

2. REQUEST FOR FUNDING

CONTEXT AND PROBLEM STATEMENT

  1. Describe the context in which you work. For example, urban/rural, demographics, main form of employment, biggest challenges faced by the community, etc.

  1. Why is it important to address GBV in your community? Please describe the issue, how it affects the community, and what its main causes are.

  1. Please describe the GBV advocacy work you are already doing and the achievements you have made so far

PROJECT DESCRIPTION

/ Please use this section to give a short overview of the project. You can give more information in the Activity Plan (Appendix).
  1. Which advocacy effort will you focus on?

  1. In relation to this goal, what specific results or changes do you want to achieve? Please list no more than three.

  1. In no more than three sentences, what activities will you undertake in order to achieve these results?

  1. a. How many people will benefit from this project?
b. How will they benefit? / Women / Men / Other
  1. How will you involve your community in the advocacy efforts (for example through volunteering, materials and/or financial support).

3. ABOUT THE ORGANISATION

STAFF, MANAGEMENT AND GOVERNANCE

  1. Please list your staff and volunteers, and indicate for each person their position, their gender, whether they are a staff member or a volunteer, and whether they are part-time or full-time.
/ Name / Position / Gender / Staff/ volunteer / Part-time/ full-time
  1. a. Please list your management team.
b. Briefly describe how the management structure of the organisation works. / Name / Position / Gender
  1. a. Please list your board members.
b. Briefly describe the role of the board in your organisation. / Name / Position / Gender
  1. What skills do the staff and board bring to the organisation? Please mention any training/mentorship that individuals or the organisation have had.

  1. How often does the staff of the organization meet? Please mark the correct box.
/ Never: / Daily:
Sometimes: / Weekly:
Monthly:

MEASURING PROGRESS AND IMPACT

  1. How do you measure progress and impact in your work? (Please attach a Monitoring and Evaluation plan)

NETWORKING, COLLABORATION AND COMMUNITY SUPPORT

  1. How do you collaborate and network with others (for example, other civil society organisations, and government departments)? Please give some examples.
/ Organisation/group / How you collaborate

FINANCIAL INFORMATION

  1. Please describe the financial systems and procedures you have in place and dedicated finance staff.

  1. Do you have audited financial statements?
/ Yes: / No:
  1. Do you have an annual work plan and budget?
/ Yes: / No:
  1. Have you received funding before? If yes, complete the table:

Received from (funder) / Amount / Purpose (for what?) / For what period of time?

4. BUDGET AND WORKPLAN

Overall project goal:
Activities
What is it, when will it take place, who will be involved, how long will it be for etc. / Target groups
Who will be targeted by each activity? / Timeframe
When the activity will happen / Indicators
For each activity, what indicators will you use to measure progress and impact?
Result 1: / Process indicators
Outcome indicators
Impact indicators
Result 2: / Process indicators
Outcomes indicators
Impact indicators
Result 3: / Process indicators
Outcome indicators
Impact indicators

BUDGET

Line item / Amount budgeted (ZAR)*
1. HR/PERSONNEL COSTS
SUBTOTAL:
2. PROJECT COSTS
2.1. Result 1
2.2. Result 2
2.3. Result 3
Other Activities
SUBTOTAL:
3. ADMINISTRATION COSTS
SUBTOTAL:
TOTAL:

1