AMBASSADE DE FRANCE EN ÉTHIOPIE

ET AUPRES DE L’UNION AFRICAINE

Civil Societies’ Innovative Projects and Coalition of Actors (PISCCA)

CONCEPT NOTE TEMPLATE[1]

PROJECT TITLE

LOCATION (region, woreda, kebele)

APPLICANT ORGANIZATION

1.1Identification of the applicant organization

Name
Address
Telephone
Email address
Contact person(s)
Legal status
Creation date
Bank account details
Number of members
Number of employees
Intervention sector(s)

1.2. Applicant’s experience

Year / Intervention
sectors / Location / Partners

POTENTIAL AND IDENTIFIED PARTNERS OF THE PROJECT (private sector, local authorities, international organizations, other NGOs etc.)

Name of the organization
Address
Telephone
Email address
Contact person(s)
Role/implication in the project

DESCRIPTION OF THE PROJECT

2.1. Summary of the project

Title of the project:

Precise location of the project:

(Region, Woreda, Kebele)

Project duration:

(12 to 24 months)

Sector(s):

2.2. Description of the project

Context of the project:

(Background analysis, constraints, identified needs and challenges, utilized methods etc.)

General Objective:

Specific Objectives:

Beneficiaries:

(Quantitative and qualitative description, implication mode in the project)

Expected results:

(Please define for each specific objective)

Results Indicators:

(Please state for each result. The quantitative indicators should precise the targeted data)

Description of planned activities:

(To be stated for each expected result or for each specific objective)

Implementation mechanism:

(Describe the chosen implementation method and the reasons of this choice)

  • role and implication of the different actors
  • proposed material means for implementing the action
  • mobilized human resource for the implementation of the action

Viability factors and sustainability of the project:

  • Monitoring and evaluation methods (qualitative and quantitative indicators)
  • Financial viability and functioning at the end of the fund
  • Possible extension of the action/ activity

FINANCIAL INFORMATION

Global planned budget

Please fill in the budget template in Excel format, enclosed to the application file (Cf. Annex1).

It is mandatory that each budget line which includes expenses and financial sources should be clearly detailed (Cf. Column “comments” of budget).

Attention: if there are other financial partners, please attach a formal letter confirming their contribution or their financial engagements[2].

1

AMBASSADE DE FRANCE EN ÉTHIOPIE

ET AUPRES DE L’UNION AFRICAINE

ANNEX 1–PROJECT BUDGET

Code / Budget column [1] / Column details / Calculation mode / Total cost ETB / Funding sources [3] / Budget repartition [4] / Comments
(for each line, precise if the contribution is in kind or financial contributions)
Unit price / Quantity [2] / PISCCA / Applicant Organization (these contributions will only concern the budget column 1 and 2) / Other funding sources / Operational cost / Administrative cost
1. / Non movable investment
Sub– total
2. / Technical and movable investment (furniture, equipment...)
Sub – total
3. / Project supporting activities
Sub– total
4. / Follow up and monitoring costs
Sous – total
5. / Evaluation and capitalization
Sous – total
TOTAL (ETB)
TOTAL (%) / 70% / 30%
[1] You can add as many lines as you want under each chapter and/or create new chapters
[2] Specify if it is a lump sum
[3] Specify the state of the co-funding or contribution (requested, promised, secured, allocated) and their origin
[4] Please note that the budget repartition must respect the 70/30 law

1

AMBASSADE DE FRANCE EN ÉTHIOPIE

ET AUPRES DE L’UNION AFRICAINE

ANNEX 2 - LIST OF REQUIRED DOCUMENTS

Please attach to the file the following documents

Administrative / Technical
Organization
  • Registration Certificate
  • Composition of the board
  • Minutes of the previous General Assembly
  • Financial report of the last year
  • Letter from the organization which confirms its financial contribution to the project
/ Local authority
  • Budget of the current year
  • Endorsement of the local authority regarding the approbation of the project and the availability of possible financial and/or in kind contribution[3]
/
  • A request letter for the validation of the project from the sectorial concerned Bureau (at regional and woreda level) [4]
  • Total planned budget of movable and non-movable investments

  • A formal request letter for PISCCA financial support
  • Agreements or MoU with other technical and financial partners

1

AMBASSADE DE FRANCE EN ÉTHIOPIE

ET AUPRES DE L’UNION AFRICAINE

ANNEX 3 – SCORING GRID

  1. Project implementing organization and stakeholders

(…) / 8
  1. Project relevance

(…) / 10
  1. Efficiency

(…) / 8
  1. Sustainability

(…) / 6
  1. Budget

(…) / 8
  1. Project location

Sub-total / (…) / 10
Total / (…) / 50

1

[1] This document is a synthesis of your project, to be filled maximum in five pages (excluding annexes)

[2] In failing of submitting the formal letter prior to the closing date, you may present your formal request letter addressed to the potential partner

[3] In failing of submitting the formal letter prior to the closing date, you may present your formal request letter addressed to the concerned local authority

[4] If not possible to provide the request letter at this stage of the selection, please note that it will be mandatory to present it at the next step