Concept Note

For a project of :

Conservation of Threatened Animal Species

(Logo of the organisation presenting the project)

Project title

Intervention country


OVERVIEW (3 pages maximum, excluding cover page)

THE ORGANISATION

Name of the NGO:

Name and details of the contact person:

Address:

Country/City/ Postal Code:

Tel:

e-mail:

Date the NGO was established:

Information about the last three years:

All amounts in EUR or USD only (please specify) / 2012 / 2013 / 2014[1]
Total budget realised
Amount received in private grants
Amount received in public grants
Number of paid employees / volunteers
Number of projects underway

THE PROJECT

Title :
Summary (3-4 lines):

Precise location (country, region/province, town/villages):

Threatened species which the project wishes to protect:

Species characteristics (number of individuals, IUCN and/or CITES classification, specificities...)

Main objective:

Secondary objective(s):

Descriptive summary of activities to reach objectives :

Total project estimated budget (in Euro only):


The Foundationcan provide up to50% of the total budget for the project, up to a maximum subsidy of € 15,000 for 2 years or less. Names of financial partners, Expected (proposal submitted but no reply), Acquired (proposal accepted but agreement not signed) or Confirmed (agreement signed), must imperatively be indicated.

TOTAL / Partner 1[2] / Partner 2[2]… / Fondation Ensemble
Expected/Acquired/Confirmed
Human resources
Cost of activities
Logistics
……..
……..
Total

% of expected funding(= proposal submited but no reply) :

% of acquired funding(= proposal accepted but agreement not signed) :

% of confirmed funding(= agreement signed) :

% of the budget requested from Fondation Ensemble:

Partners on the ground:

Duration:

Expected starting date Expected completion date:

2

Fondation Ensemble – Concept Note 2015 – Conservation of Threatened Animal Species

[1] If need be, the lastest budget update

[2] In the columns " partner 1 ", " partner 2 " and beyond, the names of the financial partners involved in the financial plan must be indicated with the indication E for expected, A for Acquired, and C for Confirmed.

[2]