DAPC Grants 2012

in the context of the Youth Initiative

FORM A – Project Proposal

PLEASE INSERT TEXT IN THE BOXES!

I.CONTACT INFORMATION

Name/ title of the project:

Name of the youth group implementing the project:

Name of the institution under which the youth group is active:

Mailing address:

Street address, Country:

Telephone:

Email:

Website:

Page on social media:

Person in charge of this project

Name:
Title:

Contact person for this project, who is able to speak English and knows the project

Name:
Title:
Email:
Telephone:

Short description of the youth group and the institution/ organisation it belongs to (including: mission statement, main activities, structure, rough volume of financing annually, main sources of funding)

Has the youth group and/or the institution/ organisation received funding from international organisations in the last 3 years?

If yes, please provide details in the table below

Donor / Amount received in US$ / Brief description of the project

II.Description of the project

Background. Short description of the reasons why the project is needed.

Objective(s) of the project

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Activities of the project, which will be implemented to achieve the objectives mentioned above. For each activity, please specify the number and kind ofparticipants (e.g. 200 youth, 50 parents, etc.)

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Number and characteristics of the DIRECT beneficiaries of the project

Number and characteristics of INDIRECT beneficiaries of the project

Short description of how the project has been planned, including the role ofyouth in this planning phase

Short description of how the activities of the projects will be organised andimplemented, including the role of youth in this implementation phase

Short description of how the activities of the project will be monitored and evaluated, including the role of youth in this monitoring and evaluation phase

Sustainability of the project. How do you anticipate project activities andoutcomes to be sustained after the end of the project?

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III.Costed workplan

Please summarise the cost and the timeframe of the activities of the project in the table below, providing details as follows (all amounts in local currency):

Activities / Timeframe / Total cost / Amount of other contributions / Source of other contributions / Amount requested to UNODC
List each of the activities that were already described above, including a simple breakdown of the costs to be incurred to implement them. / Indicate when the activity will be implemented. / Indicate the total cost of the activity. Please provide the amount in local currency. / Indicate if some of the costs of the activity will be covered by other sources by providing the exact amount. / Indicate the source of the other contributions, including the in-kind contribution from the youth group/ organisation/ institution. / Indicate the amount requested to UNODC for the activity.
Activities / Timeframe / Total cost / Amount of other contributions / Source of other contributions / Amount requested to UNODC
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TOTALS

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IV.FINANCIAL INFORMATION

Summary of the budget of the project

Information requested / Local currency / US$ equivalent
Estimated total project cost
Amount requested from UNODC
In-kind contribution from the youth group/ organisation/ institution
Amount expected from other sources

Details of bank account in which the Grant award would be deposited:

Account title:
Account number:
Bank name:
Bank address:

V.SIGNATURE

Proposal submitted by:

Name:
Title:
Signature:
Date:

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