EXPRESSION OF INTEREST FORM FOR THE ROLE OFPRINCIPAL RECIPIENT

APPLICATION DEADLINE: 11:00 AM NIGERIA TIMEON 27 AUGUST 2015

PART 1

Proposal Title:
Applicant Contact Information:
Entity Name (can be national or international; state, civil society, or private sector):
Primary Point of Contact (POC) Name:
POC Email:
POC Phone:
POC Website and/or Social Media Presence (for example Facebook, Twitter):
Possible Grant Period:
Start date:1 January 2016 / End date: 31 December 2018
Provisional Proposed Grant Period:(Must be within the timeframe indicated above.)
Start date: / End date:
National Registration of Organisation:
Legal status of organisation: / Registration number:
Date of first registration: / Date your current registration expires? (If applicable.)
Have you attached a copy of your organisation’s registration to this application? YES NO

PART 2

  1. Established relationships and credibility with the communities and population groups identified in the Call, in the geographical areas also identified in the Call.

1.1In the table below, please provide information on relationships you have established in the last three yearswith communities and population groups in the geographical areas identified in the Call:(Each description of an engagement should not exceed 250 words.)

Description and type of engagement (activity, initiative, project) / Community and/or population group / Geographical area / Description of community engagement methodology or approach used
  1. Experience and capacity in programme design and management, and project cycle management.

2.1Please insert in the space below an organigram of your organisation’s structure, reflecting its management lines, functional divisions and geographical locations.

Organigram:

2.2Please explain how your organisation’s programmes are designed and managed, including reference to specific approaches and methodologies used). Your description should not exceed 250 words.

Programme Design and Management

2.3In the space provided below, please identify the elements of the project cycle management systems (tools, frameworks and standard operating procedures) your organisation employs.Your description should not exceed 250 words.

Project Cycle Management
  1. Experience and capacity in financial management and in the management of and accounting for international donor grant funding.

3.1Please provide information on your current budget and past expenses in the table below:

Please indicate currency : / This current fiscal year / Last year / The year before last
Total Expense Budget / ?
Total actual expenses / ? / ?
Budget linked to subgrants / ?
Actual expenses linked to subgrants / ? / ?

3.2Please provide information below on the four largest grants your organisation is currently managing:

Name of project / Donor(s) / Total Value and currency / Share or value for Sub-Recipients
Grant 1
Grant 2
Grant 3
Grant 4

3.3Please provide the following information on the statutory audits your organisation underwent in each of the last three years. If no statutory audit took place in any particular year, please explain why in a paragraph below the table. Please state the auditors’ opinion (unqualified or qualified and if qualified, please explain why in the “Comment” column)

Statutory audit (yes/no) / Audit firm / Opinion / Comment
Latest audit
The previous year
The year before that

3.4Please provide information of the last three donor-mandated audits your organisation was subjected to. If no donor-mandated audit has ever taken place, please indicate so in a paragraph below the table and explain why. Please state the auditors’ opinion (unqualified or qualified and if qualified, please explain why in the “Comment” column)

Donor Name / Size of grant / Number of Sub-Recipients if any / Opinion / Comment
Latest audit
Second latest audit
The preceding audit
  1. Experience and capacity in working within a Consortium and/or managing sub-recipients.

4.1In the table below, please provide the information requested below on your experience of working with a Consortium and/or managing sub-recipients in the last three years. Please indicate: (i) the name of the Consortium with which you worked, and/or describe the context in which you were managing sub-recipients; (ii) the purpose of the collaboration; (iii) your organisation’s role and contribution; and (iv) who provided the funding for the collaboration.

Name/Context / Purpose / Role / Source of funding

4.2Please identify the most relevant capacities your organisation has to successfully lead a Consortium and manage sub-recipients in the table below:

Capacity / Description(The description of each capacity should not exceed 150 words.)
  1. Experience and capacity in community-level initiatives that address the local drivers of violent extremism and strengthen resilience against violent extremist agendas.

5.1Please provide information on your organisation’s community-level initiatives that address the local drivers of violent extremism and strengthen resilience against violent extremist agendas in the last 3 years:(The description of each project (name, purpose and activities) should not exceed 250 words.)

Name of Project / Purpose of Project / Activities of Project

Declaration on the Role of Principal Recipient

If your organisation is selected as a potential Principal Recipient, you will be expected to form a Consortium of potential Sub-Recipients that meets the expectations of both a GCERF Consortium and Sub-Recipients. A Principal Recipient is responsible for coordinating the development of a Consortium Grant Application. A Principal Recipient is expected to establish written agreements with each potential Sub-Recipient prior to the submission of a Consortium Grant Application.

Please indicate with an “X” below that your organisation acknowledges and accepts the role of a Principal Recipient as described above.

_____ My organisation acknowledges and accepts the role of a Principal Recipient as described above.