APPLICATION FORM FOR FINANCIAL SUPPORT 2018

Dutch Albert Schweitzer Foundation NASF

In order to apply for funds, we request the following:

  1. Completed Application Form
  2. Completed Bank Account Sheet
  3. Detailed project budget

Requests for funds will only be considered if the 3 above listed required documents are completed and included in the application. It is also strongly advised to include photo’s in your application or any other additional information or documents to support your application. Please include such documents as attachments (email) or appendices (post) to your application, and clearly list them at the bottom of this form.

Applications should be sent to the email address: . Applications sent to any other NASF email address will unfortunately not be accepted as applications. You might also fill in this form and print it and send it as a hard copy by regular post to this address:

Dutch Albert Schweitzer Foundation (NASF)

PO Box 8568

3503 RN Utrecht

The Netherlands

For more information please visit our website :

  1. Contact information applying organisation

Name of organisation
Country
Address
Email address of the organisation
Telephone
(Indicate at least two telephone numbers) / 1.
2.
Address Skype
Website
Name contact person / Function m/f
Email address

B.Project

Name of the project
Total amount requested
(in local currency and in Euros)
Duration of the project
(how many months)
Location of the project
(country, region, city)
Main focus of the project?
(for example: health, education, income generation, clean water & sanitation, mother/childcare etc.)
Target group (s) of the project
(main target group and how many people involved) / 1)..
2)..
3)..
Objectives of the project:
●..
●..
Project activities:
●..
●..
●..
●..
Description of the project (maximum 150 words):
Are there any other donors or project partners involved? If so which ones?
  1. Organisation

Type of organisation
(NGO, volunteers, school, church organization etc.)
Objectives of the organisation:
●..
●..
●..
Short description of your organization : (maximum100 words)
(number of staff, volunteers, history, organisational set up, composition of Board, etc.)
Has your organisation implemented other projects ? If yes, when, which projects and in collaboration with which organisations ?
Have you previously submitted an application to NASF ? If yes, when (date) ?
(This does not affect the appraisal of the application.)

Required Appendices:

❑Detailed Project Budget
❑Completed Bank Account Sheet
If available:
❑Recent annual report of your organisation including financial report
❑Copy of NGO registration certificate
❑References, if any
❑Any other………………………………………………………….
Date / Place
Name (project responsible)
Signature / Name (contact person)
Signature

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