CIMB Foundation - Inquiry form

Branch Details / Branch/Branch Manager/ARM/RD
1.  / Office/branch details / CIMB UKM Branch
2.  / Contact person and contact details / Will be filled by Pejabat Hubungan Universiti-Masyarakat
Applicant’s Details / Tell us about your organisation
3.  / Grant applicant / What is your organisation’s name?
4.  / Date established / When were you established?
5.  / Focus areas / What are the main focus areas of your organisation?
6.  / Previous notable projects / Tell us about some projects which you have implemented. We are particularly interested about the scale and outcome of the projects.
7.  / Office/branch details / We’d like to know where your office is, and how many staff you have.
Project Details / Tell us about the project
8.  / Project name / What will you name this project?
9.  / Location / Where will this project be implemented?
10.  / Time period / How long will the project run? When will the project start and end?
11.  / Beneficiaries / Who are the people benefiting from the project, and how many beneficiaries are there?
12.  / Needs identified / What are their needs which you have identified which will be addressed by the project?
13.  / Project objectives / What will the project achieve, and what is the end result for the beneficiaries?
You should describe the outcome in concrete terms in words and numbers.
14.  / Expected outputs / State the outputs and the deliverables at the end of the project.
15.  / Budget / How much do you need for this project?
(i) What will the funds be used for
(ii) State in as much detail as you can.
16.  / Other sources of funding / Have you applied for other funding for this project?
If Yes, who have you applied to, and for how much?
17.  / Resources committed by applicant / What resources are you committing to this project? People, funds, know-how and other resources?
18.  / Other partners / Do you intend to collaborate with other partners? Who are they, and have they confirmed their participation? How will they contribute to the project?
Contact Details
19.  / Contact person and contact details / Whom can we contact for further information? Please let us have your representative’s name, designation, mobile phone number, fax number and email address.