Ajinomoto International Cooperation For

2012 Project Grants

Application Form

Ajinomoto International Cooperation for

“Nutrition and Health” Support Program

1. Applicant Profile (Please use only this page)

Name of applicant organization
<Accompanying material:
annual reports for fiscal 2009 and fiscal 2010> / (Japanese)
(English)
Address
Representative / Name: Title:
Person in charge / Name: Title:
Tel: / Fax:
E-mail:
Base of operations in targeted country
(Branch office or counterpart) / In the case of a local counterpart, please enter the name of the organization:
(English)
Address:
Person in charge
in targeted country / Name: Title:
Tel: / Fax:
E-mail:
Outline of applicant organization / (1) Objectives and philosophy of establishment:
(2) Year established:
(3) Number of staff members:
Paid: persons; Unpaid: persons
(4) Budget and main revenue sources for current fiscal year:
(5) Main projects and countries of activity:
Organization’s website:
If base of operations in targeted country is a local counterpart, give its outline / (1) Objectives and philosophy of establishment:
(2) Year established:
(3) Number of staff members:
Paid: persons; Unpaid: persons
(4) Budget and main revenue sources for current fiscal year:
(5) Main projects and countries of activity:
Organization’s website:

2. Proposed Project (Please use only this page)

Project title / (Japanese)
(English)
Amount applied for
<Attachment 1: Budget Plan> / (Total) (yen)
1st year: (yen) / 2nd year: (yen) / 3rd year: (yen)
Project period / (Period for which the project will be supported by Ajinomoto Co., Inc.)
MM DD YY
From: April 1, 2012 To: / /
(Duration: yrs. months)
Project site (country and region) / (Japanese)
(English)
Background and necessity of project
Description and number of main project beneficiaries
Project purpose and specific goals
Activities to be
implemented (list details on Attachment 2)
<Attachment 2: Activity Plan (Schedule) >
Implementation structure
Potential for self-reliant development after the grant period ends

3. Application History (Please check all boxes that apply)

□ You have previously received a grant from Ajinomoto Co., Inc. / Project title:
Grant amount: (yen)
MM DD YY MM DD YY
Implementation period: From / / To / /
□ You are currently receiving (or applying for) a grant from Ajinomoto Co., Inc. for another project (theme). / Project title:
Grant amount: (yen)
MM DD YY MM DD YY
Implementation period: From / / To / /
(If you are currently applying for a grant) MM DD YY
Application date: / /
□ You are currently receiving (or applying for) a grant from another organization for a similar project (theme). / Name of the other organization:
MM DD YY MM DD YY
Implementation period: From / / To / /
Grant amount: (yen)
(If you are currently applying for a grant) MM DD YY
Application date: / /

How did you learn about this program?

Please indicate the media through which you came to know of this program (multiple answers allowed).

 Printed “Information for Applicants”

 Ajinomoto website

 Other website (Title of website: )

 Mailing list (Name of mailing list: )

 Newsletter of organization or group (Title of newsletter: )

 Newspaper or magazine (Title: )

 Friend or acquaintance

 Other (Please specify: )

Opinions regarding this program

If you have any opinions or comments regarding this program or the Information for Applicants, please enter them here. (Your comments will be useful to us in operating the program in the future. This section has no bearing whatsoever on the selection of projects for grants.)

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