Fonds Social de Développement – Application Form
Consulat Général de France
FONDS SOCIAL DE DEVELOPPEMENT (FSD)
SOCIAL DEVELOPMENT FUND
الصندوق الاجتماعي للتنمية
FORMULAIRE DE DEMANDE DE SUBVENTION
APPLICATION FORM FOR A GRANT
استمارة طلب التمويل
Name of proposed project:
Name of Organisation:
Name and details of contact person at organisation:
Project location:
Project duration:
Estimated cost of the proposed project:
Total:
FSD grant requested:
Total partner(s) contribution:
DOCUMENT I – OFFICIAL LETTER FOR FINANCING
The official letter for financing should include the following elements:
Name of the organisation
Contact information (address, phone number, fax, e-mail)
Main interlocutor (name, position, qualification, address, mobile phone number, e-mail)
Summary of the project
- Project title
- General goals
- Total amount of the project (in NIS)
- Amount of the grant requested (in NIS, at the most 70%)
- Amount of the participation of the beneficiaries (in NIS, at least 10%)
- Amount of the possible co-financing brought by other partners (in NIS)
Date and signature of the person legally in charge
DOCUMENT II – ADMINISTRATIVE DOCUMENT
(a)INSTITUTION – Contact InformationName
Address
Phone number
Fax number
(b)INSTITUTION – Legal Information – please enclose legal status
Legal status (NGO, municipality, etc.)
Date of creation
Membership in an NGO network (please specify)
(c)INSTITUTION – Bank Information – please enclose bank details information
Name of the account holder
Bank
Account number
(d)INSTITUTION – Organisational Information – please enclose names of the board
Board & General Assembly
(existence, rules of functioning, number of members, date of last meeting, etc.)
Human resources / permanent, temporary employees or volunteers (please describe)
In kind resources (please describe)
(e)INSTITUTION – General Information
Sectors of intervention
(please describe)
Geographical areas of intervention
(please describe)
(f)INSTITUTION – Financial Information
Payroll (in NIS) / 2011
2010
2009
Budget (in NIS) / 2011
2010
2009
Sources of funding (name, nature, amount, year)
External audit (name, contact, year)
(g)INSTITUTION – Partnership Information
Previous projects in partnership
with France (Consulate general, AFD, NGO, twinning, etc.) / Name / Description / Year / Amount
Main projects in partnership with other donors / Name / Description / Year / Amount
(h)INSTITUTION – Documents to be attached
Status and rules of procedure of the applicant institution
Certificate of registration
Organisational chart
List of Board Members (name, position, number of years in post)
Audit (if available)
Last annual report (if available)
Official details of the bank account
Precise map of the project location
DOCUMENT III – TECHNICAL DOCUMENT
(i)PROJECT – General InformationName
Sector
Location / City/village
District
Duration
Summary
(main objectives,
main activities, justification, etc.)
(j)PROJECT MANAGER – Contact Information
Name
Position
Phone number
(k)PROJECT – Description
Context (needs assessment, project justification, etc.)
Compliance with FSD priorities
Target beneficiaries - direct and indirect - (number, gender, age, situation, etc.)
Qualitative goals
Quantitative goals / Quantitative Goals / Indicators of success / Sources of verification
1.
2.
…
Expected outputs for the beneficiaries (please describe what will be directly created by the project) / Created jobs (in person-days)
Generated revenue
Training/ empowerment
Social services
Others
Expected outcomes and impacts on beneficiaries (please describe what will be the effects, direct or indirect, on beneficiaries)
Risks in project implementation
Appreciation of the project sustainability (please describe what will remain after the project)
(l)PROJECT – Organisational Information
Staff / Name / Position / Qualification / Responsibilities in the project
Role of beneficiaries in the project
Role of partners in the project
1
Consulat Général de France à Jérusalem - Service de Coopération et d’Action Culturelle
3 rue Bibers - PO Box 182JERUSALEM
Tel : +972 2 591 40 00 - Fax: +972 2 591 40 01
Fonds Social de Développement – Application Form
Consulat Général de France
(m)PROJECT – Execution modalitiesGoals / Activities / Expected outcomes (number of beneficiaries, deliverables, job creations…) / Human ressources / Funded by
-
- / -
- / -
- / -
-
-
- / -
- / -
- / -
-
-
- / -
- / -
- / -
-
-
- / -
- / -
- / -
-
(n)PROJECT – Agenda
Year / Year 1 / Year 2
Month / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12
Activity 1
Activity 2
Activity 3
…
Consulat Général de France à Jérusalem - Service de Coopération et d’Action Culturelle
3 rue Bibers - PO Box 182JERUSALEM
Tel : +972 2 591 40 00 - Fax: +972 2 591 40 01
Fonds Social de Développement – Application Form
Consulat Général de France
(o)PROJECT – Monitoring & EvaluationMethods of monitoring (please describe)
Persons in charge of monitoring
Methods of evaluation (please describe)
Persons in charge of evaluation
(p)PROJECT – General budget
Source / Amount (in NIS) / Per Cent (%) / Nature
FSD grant / ( < 70 %)
Applicant institution / ( > 10 %)
Beneficiary community
Other donors (specify)
Total budget / 100 %
(q)PROJECT – Detailed budget
Item / Total budget (NIS) / FSD contribution (NIS)
Furnitureequipment:
Details:
-
-
Training:
Details:
-
-
Salaries:
Details:
-
-
Transports:
Details:
-
-
Investments in real estate:
Details:
-
-
Technical installations:
Details:
-
-
Surveys:
Details:
-
-
External services:
Details:
-
-
Others:
Details:
-
-
TOTAL
(r)PROJECT – contact information of financial partners
Name / Activity / Address / Phone number / E-mail
(s)PROJECT – Any other information
Consulat Général de France à Jérusalem - Service de Coopération et d’Action Culturelle
3 rue Bibers - PO Box 182JERUSALEM
Tel : +972 2 591 40 00 - Fax: +972 2 591 40 01