Instructions
This form is to be completed by the applicant. The form may be typed or handwritten. The form must be submitted to theAustralian Embassy, Yangon by 4pm (local time) on27September 2013. Late applications will not be accepted without prior agreement from the Embassy. Due to the high number of quality applications received each year incomplete applications will not be considered.All applications must be accompanied by a fully costed budget, a risk assessment and, for applicants who have not previously received Australian Government funding, referee reports.
APPLICANT ORGANISATION AND CONTACT DETAILS
Name of organisation
Organisation goal or purpose
Street address
City
Country
Postcode
Name of contact person
Honorific (tick one) / ☐Daw☐Mrs☐Ms☐Miss☐U☐Mr☐Other:
Position
Contact numbers / Work Mobile Fax
Email address
PROJECT DETAILS (maximum 4 pages)
Name of project / [Enter project name here]
Briefly (in 4 to 6 sentences) describe the main elements of the project and why it is needed. / [What are the main objectives of the project? What problems does it aim to solve?]
Amount of funding being sought from the Direct Aid Program (in AUD, USD or MMK)NB: Funds are paid in cash (USD) in-country or by electronic funds transferif funds are to be received outside Myanmar.
Total cost of project (in AUD, USD or MMK)
Project start and end date
NB:Successful recipients must spend DAP funds by 30 June 2014. Projects requiring funds beyond this date will not be considered.
State/region, city, and township where project activities will occur
Which of the following are objectives of this project? (Please tick one or more)
☐Poverty alleviation
☐Community-level health, education and sanitation
☐Enhancing sustainability through restoration and protection of the environment and facilitating sustainable growth
☐Basic human rights
☐Rural development
☐Gender equality
☐Conferences or training
☐Cultural or sporting activities
☐Disaster relief
☐Other – please note:
What are the specific anticipated outcomes of this project? (150-250 words) / [What are the potential benefits of the project (social, economic, environmental)? Who are the main beneficiaries? (Please include estimates of the number of people who will benefit if possible).]
How will those outcomes be achieved? (150-200 words) / [How will the project be implemented? What assumptions have been made when designing the project? For example, are government permissions needed, does the project require access to office space or land, have relevant staff been recruited, does the project require access to special expertise? What are the challenges to implementing your project?]
Has the local community been consulted about this project? Please provide details of community consultations (100-200 words) / [What is your consultation strategy for the project? Include a brief summary of consultations with stakeholders to date and their respective levels of support for the project.]
How will you promote the project and the Australian Government’s funding contribution?
What partners, if any, are involved in the project? / [Please include details of their role in the project and their relationship to your organization.].
Does the project have other funding sources? If so, indicate the source and amount. / [This can include funds or in-kind support from other donors or from the community involved.]
Does this project involve participation by both men and women? / [Briefly provide details of the participation of men and women in the design and implementation of your project.].
Does the project involve the participation of marginalized groups? For example, people with disability. / [If yes, please provide brief details of their participation in your project.].
Has the organisation previously received DAP funding? / [If YES, provide details (e.g. project, amount, year). Has a Project Completion Report (including full acquittal) been submitted?]
Has the organisation previously received any other Australian Government funding? / [If YES, provide details (e.g. project, amount, year). Has a Completion Report (including full acquittal) been submitted?]
NB: If the organisation has not previously received Australian Government funding (including DAP), please also attach references from two independent sources (including contact details for referees) and a copy of the organisation’s certificate of registration.NB: The application will be treated as incomplete if this information is not provided.
Does the project involve working with children? / [If YES, the organisation must have a current child protection policy or code of conduct to be eligible for funding; please attach a copy of the organisation’s child protection policy or code of conduct to this form when applying for DAP funding.].
NB: The Australian Government believes in the fundamental right of children to grow up safely and enjoy a childhood that is free from exploitation and abuse. It is critical that projects funded under the Direct Aid Program safeguard children from exploitation and abuse of all kinds by creating and maintaining protective environments.Please see Attachment A for an example of a child protection code of conduct.
Please specify the real or potential risks associated with the project. Please tickone or more of the boxes below and provide a brief outline of how you will manage these risks (150- 300 words). NB: Applications that do not include a proper risk assessment will be treated as incomplete.
Physical risks☐Child related risks☐Environmental risks☐
Political risks☐Economic risks☐Social risks☐
NB: Building or construction projects generally involve some potential physical and environmental risks. Where possible, building or construction projects should meet or exceed Australian safety standards.Where Australian standards cannot be met, the project should meet WHO standards. DAP does not allow the use of asbestos as a building material.
Building or construction projects must have approval from the relevant domestic authority to be eligible for DAP funding. Please provide evidence that the relevant approvals have been granted.
Attachment A
Sample Child Protection Code of Conduct
Child protection code of conduct
I, [insert name], engaged by [organisation], agree that while implementing DAP-funded activities, I must:
- treat children with respect regardless of race, colour, gender, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status
- not use language or behaviour towards children that is inappropriate, harassing, abusive, sexually provocative, demeaning or culturally inappropriate
- not engage children under the age of 18 in any form of sexual intercourse or sexual activity, including paying for sexual services or acts
- wherever possible, ensure that another adult is present when working in the proximity of children
- not invite unaccompanied children into my home, unless they are at immediate risk of injury or in physical danger
- not sleep close to unsupervised children unless absolutely necessary, in which case I must obtain my supervisor’s permission, and ensure that another adult is present ifpossible
- use any computers, mobile phones, video cameras, cameras or social media appropriately, and never to exploit or harass children or access child exploitation material through anymedium
- not use physical punishment on children
- not hire children for domestic or other labour which is inappropriate given their age or developmental stage, which interferes with their time available for education and recreational activities, or which places them at significant risk of injury
- comply with all relevant legislation, including labour laws in relation to child labour
- immediately report concerns or allegations of child exploitation and abuse in accordance with appropriate procedures
- immediately disclose all charges, convictions and other outcomes of an offence, which occurred before or occurs during my association with the Direct Aid Program that relate to child exploitation and abuse.
When photographing or filming a child or using children’s images for work-related purposes, I must:
- assess and endeavour to comply with local traditions or restrictions for reproducing personal images before photographing or filming a child
- obtain informed consent from the child and parent or guardian of the child before photographing or filming a child. As part of this I must explain how the photograph or film will be used
- ensure photographs, films, videos and DVDs present children in a dignified and respectful manner and not in a vulnerable or submissive manner. Children should be adequately clothed and not in poses that could be seen as sexually suggestive
- ensure images are honest representations of the context and the facts
- ensure file labels, meta data or text descriptions do not reveal identifying information about a child when sending images electronically or publishing images in any form.
- I understand that the onus is on me, as a person associated with the Direct Aid Program, to use common sense and avoid actions or behaviours that could be construed as child exploitation andabuse.
Signed:
Date
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