Canada Fund For Local Initiatives in Mexico

Application for Project Funding by the Canada Fund 2013-2014

  1. Information on the project and your organization:

A) Project title: ______

(Please provide a descriptive title. For example: “Food Security for Sustainable Development of Rural Communities in Oaxaca.”)

B) Name of community/group: ______

C) Is the organization legally constituted? If so, please scan and attach the following two pages of the act to constitute the organization to your email application:

  1. The first page (where the name of the organization appears);
  2. The second page (where the signatures appear).

D) Location of Proposed Project:

City/village: ______

District: ______

State: ______

E) Contact person: ______

Title/function: ______

Address: ______

______

______

Phone:______

Cellular: ______

Fax: ______

E-mail ______

F) Brief description of the community/group submitting the project (i.e., date of establishment of the group, mandate, membership, etc.)

______

______

______

______

______

______

G) Explain existing link or relation between its organization and the local government authorities. Do you need local authority and/or government approval to carry out the project?

______

______

______

  1. Project description:
  1. Brief description of the project:
  1. What is the purpose of the project?

______

______

  1. What will the project achieve, i.e., what are the immediate expected results of the project? What changes are directly attributable to the project activities?

______

______

______

______

  1. Which indicators will be used to measure the achievement of the objectives?

______

______

______

______

  1. Over what period of time will the project be implemented?

______

______

  1. What are the main activities of the project (in point form only)? Actions to be undertaken to gain outputs?

______

______

______

  1. Are there any major risks of which you are aware that could affect the successful implementation of the project? How will they be reduced?

______

______

______

  1. Other features of the project which you consider important.

______

______

______

  1. Describe any possible environmental impacts or benefits the project might have.

______

______

______

  1. Origin and Context:

Describe the region and community where the project will be implemented and the reason motivating the request for assistance. What does the local community think of the project?

______

______

______

______

______

______

  1. Beneficiaries and Participants:
  1. Who will benefit from the project and how will these benefits be realized? (Total number of recipients and number of women/children.)

______

______

______

  1. Were the beneficiaries involved in the decision to seek funding and the planning and design of the project? If so, how?

______

______

______

  1. How and to what extent will the beneficiaries participate in the implementation of the project?

______

______

______

  1. When the project has been completed, what will their future participation be?

______

______

______

  1. List the names of the members of the local committee responsible for submitting this proposal along with their functions and responsibilities.

______

______

______

  1. List the names and responsibilities of the key individuals to be involved in the implementation of the project.

______

______

______

  1. How have you considered the differential impact this project will have on women and men, boys and girls in the community?

______

______

______

  1. Summary Project Budget:

[We recommend that you include the full budget as an attachment to this document.]

ii) Show, in Mexican pesos, the proposed budget by type of activity and who would contribute to each activity. Please specify in each activity all items and their cost. A sample format follows:

(Type of activity) (Contribution by :)

Canada / Recipient(s) / Others* / Total
Services
Training
Equipment
Construction
Administration expenses
Others (specify)
Total

* Specify source of, and reason for, other contributions.

  1. Resources requested from the Canada Fund:

Specify the exact nature of the assistance requested from the Canada Fund: type/kind of services, equipment, products or construction, etc. If the project includes construction (for example, a water cistern or greenhouse), please specify the following dimensions: surface area (square meters) and total height (meters) of the construction.

______

______

______

______

______

______

  1. Community resources:

Specify the resources that are available from the community itself, other donors, and the government which have been committed to help finance/implement the proposed project. Please include donations in kind (manual labour, etc.) provided by the group of beneficiaries.

______

______

______

______

______

______

  1. Past Experience
  1. Describe any (relevant) projects already implemented by the community, including the source of funding, the means of execution, and the results.

______

______

______

  1. Give information on any previous projects supported by the Government of Canada - when was the project funded, for how much, what Program or Department, whether the project was successfully completed. If your organization has any outstanding debts to the Government of Canada from previous projects, please explain.

______

______

______

Prepared by:

Name:______

Signature: ______

Position: ______

Date:______

[More than one signature may be given, if desired.]

Name:______

Signature: ______

Position: ______

Date:______

Name:______

Signature: ______

Position: ______

Date:______

Name:______

Signature: ______

Position: ______

Date:______

1