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HIGH COMMISSIONER'S

DIRECT AID PROGRAM (DAP)

ATTACHMENT A:

APP DAP NO: ______

APPLICATION FOR FINANCIAL ASSISTANCE

This form is designed to help you present your application for financial assistance under the

High Commissioner's Direct Aid Program (DAP).

(Please submit application typed or neatly handwritten to:
The DAP Co-ordinator, Australian High Commission, PO Box 704, APIA.

Or via email to )

  1. Project Details:

Name of Project:______

Name of Organisation/NGO/Group applying:

______

Name of Project Co-ordinator or representative:

______

Address & Contact No: (It isIMPORTANT to include this information for contact purposes)

______

Location of Project:

______

  1. Please list down what is needed for the proposed project:

(Please list down in details e.g. equipment, materials etc and attached 2 pro forma invoices from 2 separate suppliers)

NOTE: For building projects, includes new buildings, renovations or upgrading of existing building, security fence, signage etc, an approval from Planning & Urban Management Agency (PUMA), Ministry of Natural Resources & Environment (MNRE) is required once approval for funds has been granted.

  1. Brief Description of Project: (Please state clearly the objective(s) to be achieved by the project)
  1. State the problem the project will address: (Please explain in details the current situation)
  1. State the proposed solution: (State clearly how the implementation of the project will help the situation & define ways to sustain the project)
  1. What would be the expected outcome of the project?

(Please explain in details how the project would achieve its objectives as defined above)

  1. Who and how many will benefit from this project:

(Please write in clear details the expected impact of the project to the development of the target Community/organisation/group)

  1. How many months will be required to complete the project after funds are received?
  1. Will there be recurrent costs associated with the project? If so, how will these costs be sustained? Please explain.
  1. Have you applied/received financial assistance from any other High Commission/Organisation: If yes, please give details:

Donor’s Name:
Date:
Amount Donated:
  1. Have you previously received funding from the Australian High Commission (AHC)

(i.e. AusAID, ASPCF, DAP)? If yes, please give details:

AHC Program:
Date:
Amount granted:
  1. Is this proposed project/Activity being CO-FUNDED by other Donor(s)?

(If yes, please provide details of Donor Organisation and amount approved/received).

  1. Is this proposed project/activity submitted being implemented in conjunction with other activities funded through other sources?

(If yes, please state clearly funding source(s), amount received and combined activity.)

  1. Are you currently applying or applied for funding and was granted funds from the Civil Society Support Program (CSSP)? If YES: please state as follows:

Name of Project/Activity approved by CSSP:
Village:
Amount granted:
Date:
  1. What is the contribution by the local community or Organisation:
  1. Cost of Project:

Local Contribution: / WST______
DAP Contribution: / WST______
Total Cost for the Project: / WST______

At least two (2) Quotations/Pro-forma invoices from Suppliers must be provided to support the application.

Please attach to the application when submitting.

  1. Are there any additional information to support the proposal that you would like to add?

Please NOTE: that the Direct Aid Program (DAP) Committee, will request if necessary, further documentation to finalise the assessment of the project application.

Signature of Project Coordinator/Executive committee: (NOTE: application must be signed by at least 3 members)

Date:

Supporting Documents to be attached with application:

Check List: (Please tick where applicable)

NOTE: All applications must be submitted with a ‘Maintenance Plan’ for the project.

Construction projects:

  • 3Contractor’s Quotes including list of materials and costing;
  • Draft of Building Design in A4 paper;
  • Land Agreement if property is not owned;
  • Maintenance Plan
  • Supporting letter from:
  1. Village Matai Council, signed by 3-4 members;
  2. Women’s community, signed by 3 representatives;

PLEASE DO NOT SUBMIT THE FOLLOWINGREQUIREMENTS MARKED IN ‘RED’ BELOW WITH THE APPLICATION. ONLY WHEN REQUESTED BY THE OFFICE:

  • Development Consent from MNRE - PUMA
  • Building Permit from Ministry of Works (MWTI)
  • Sewing Workshop/Training: supporting letter/Confirmation from
  1. Ministry of Women, Community & Social Development – Women Division;
  2. Qualified Seamstress (qualification to be attached);
  3. Sewing machine warranty from Supplier;
  4. Sewing workshop/training Program;
  5. 3 Separate Quotes from 3 different Suppliers for sewing machines.
  • Computer Training:
  1. Letter of Agreement from a qualified computer individual or organisation, agreeing to conduct training;
  2. Evidence of proper facility (with air conditioning) to house computers;
  3. Computer(s) warranty from Supplier.
  4. Computer training Program;
  5. Qualified IT Personnel to look after maintenance of IT Equipment;
  6. Maintenance Plan.
  • Water Tanks:
  1. Development consent from MNRE – PUMA;
  2. Permit – Ministry of Works;
  3. 3 quotes from three different suppliers;
  4. Statement Letter/Agreement to open access to water tank by other members of the community;
  5. Maintenance Plan
  • Agricultural projects:
  1. Chemicals such as pesticides, fertilizers etc are prohibited for funding;
  2. Chemical packs/accessories are prohibited;
  3. Quotes on gardening/farming tools are allowed;
  4. 3 separate Quotes from three suppliers.
  • Other Projects not listed above:
  1. Please provide supporting documents applicable to the application.
  2. All project applications must be submitted together with a Maintenance Plan.

Revised January 2016