AUSTRALIAN EMBASSY
19th floor, Kyobo Building
Jongno 1-ga, Jongno-ku
Seoul 110-714
Fax: +82 2 2003 0212
DIRECT AID PROGRAM (DAP) APPLICATION FORM - MONGOLIA
To be filled out in English
Please read the DAP Guidelines carefully before filling out this form.
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PROJECT SUMMARY AND CONTACT DETAILS
Please complete this form with as much detail as possible.
PROJECT TITLE:
PROJECT LOCATION:Mongolia
Aimag / CityNAME OF THE ORGANISATION PROPOSING THE PROJECT:
MAIN ROLE OF THIS ORGANISATION (eg. Environmental, education outcomes etc.):
HAS YOUR ORGANISATION PREVIOUSLY BEEN FUNDED BY THE AUSTRALIAN GOVERNMENT (UNDER DAP OR ANOTHER PROGRAM)? Yes / No
IF YES, PLEASE GIVE DETAILS
NAME OR NAMES OF PERSON/S RESPONSIBLE FOR THE PROJECT:
Address:
Email Address:
Telephone Number/s
Fax Number
Website (if applicable)
IF THE MAIN CONTACT PERSON DOES NOT SPEAK ENGLISH, PLEASE PROVIDE THE NAME AND CONTACT DETAILS OF AN INTERMEDIARY WHO CAN ASSIST WITH COMMUNICATION IN ENGLISH
IS YOUR PROJECT A NEW PROJECT, OR A CONTINUATION OF AN EXISTING ONE?
New / Continuation
TOTAL AMOUNT OF CONTRIBUTION BY YOUR ORGANISATION:
TOTAL AMOUNT OF FUNDING FROM OTHER ORGANISATIONS:
(eg. by local government or provincial authorities; other funding agencies)
TOTAL COST OF PROJECT:NAME/S OF OTHER CONTRIBUTING FUNDING ORGANISATION/S (if any)
(1)(2)
(3)
(4)
HAVE YOU SUBMITTED THIS SAME PROJECT PROPOSAL TO OTHER ORGANISATIONS NOT LISTED ABOVE?
Yes / No
If yes, please state which organisation/s and amount requested
(1)(2)
(3)
(4)
HOW DID YOU FIND OUT ABOUT THE DIRECT AID PROGRAM?
1.LOCATION OF THE PROJECT
Where will the project be implemented?
What is the area like (population, geography, environment)?
What are the special features of this town/area (employment, per capita income, social or economic issues, recent developments)?
Please provide a map of the location, if possible.
2.STATE THE PROBLEM YOUR PROJECT WILL ADDRESS
Why is this project necessary? What is the problem you are trying to address?
- STATE THE PROPOSED SOLUTION TO THE PROBLEM
What is the aim of your project?How will your project address or help to solve the problem you have outlined above? How will the project be implemented? How will the project contribute to development in the location? What will be the long-term impact of the project?
4.WHO WILL UNDERTAKE THE PROJECT?
Please list all of the main people and organisations involved in this project, and what their roles will be. For the project manager(s), if possible, please provide a brief CV.
- WHO WILL BENEFIT FROM THE PROJECT?
The project should benefit a particular community or group (eg. Students, women, disadvantaged or other groups….). Please describe any special characteristics of this community or group, and how the project will help its members.
6.PLEASE PROVIDE A DETAILED BUDGET FOR THE PROJECT
(NOTE: DAP GRANT LIMIT IS AUSTRALIAN $10,000.00)
How will you spend the DAP grant? Please attach a detailed sample budget, including quotations for materials (if available). The cost of the project should be broken down into clearly defined categories such as equipment, labour, materials, transport, etc. Equipment and materials to be purchased should be itemised and individually costed.
Please note: DAP funds should not be used primarily to fund labour costs or per diems for staff. DAP funds may only cover these costs as a small component of the project costs covered by DAP.
Sample:
Item / Description / Cost (unit) MNT / Cost (total)MNT / Funded by DAP / Funded by x organisation
Bricks / For construction of reading room / 500 / 500,000 / 250,000 / 250,000
Text books / For high school students / 10,000 / 300,000 / 300,000
Labour / Building of reading room / Donated by volunteers
Your budget: (please adapt and add rows as necessary; please provide a total sum)
Item / Description / Cost (unit) MNT / Cost (total)MNT / Funded by DAP / Funded by
7.WHAT CONTRIBUTION, IF ANY, WILL YOUR ORGANISATION PROVIDE?
For example, funds, labour, transport, venue or perhaps materials
8.WHAT CONTRIBUTION, IF ANY, WILL BE PROVIDED BY OTHER SOURCES?
Please list the names of the contributing organisations and the precise amount or contribution each will provide. Attach letters or documents confirming these contributions from other sources.
9.APPROXIMATELY HOW LONG WILL THE PROJECT TAKE TO COMPLETE? WHEN DO YOU EXPECT THE PROJECT TO START AND FINISH?
Please also explain any seasonal conditions (eg. Project must take place during summer months)
Please note project funds must be spent by the end of June 2015. The project should be completed as close as possible to that time and final report submitted.
10.ADDITIONAL INFORMATION
Please provide any further information you consider helpful. (Attach additional pages if necessary.)
Please attach references (from previous partners, local authorities, government departments etc), and evidence of previous projects your organisation has implemented.
The DAP Committee would welcome any photographs, maps, sketches that you might be able to include to help explain your project.
11.DECLARATION
I certify that the information contained in this application is true and correct.
I have read and understood the DAP Guidelines, including requirements for acquittal, reporting, and return of unused funds. Should our organisation be successful, we will abide by these guidelines.
I have included the following detailed information in my application:
-Full, itemised budget
-Evidence of cooperation from other organisations (eg. Copy of letter)
-Reference/s from previous partners, local authorities or government attesting to the organisation’s previous activities
-CV/biography of the main project manager
Signed
Name
Date
1