International Project Funding Proposals

APPLICATION FORM

INTERNATIONAL PROJECT FUNDING PROPOSALS

Applications should be sent to the Canadian Hemophilia Society via e-mail to . Grant applications should be received ideally before February 15, but may be received as late as June 30 of the same year. Grants are normally for one year or less and should not go beyond December 31 unless approved ahead of time (or an extension is given) by the International Grants Committee. Grants can be renewed. Grants are in the range of $1,000 to $15,000 per year. Projects commence when accepted but funds will normally be disbursed in two (2) payments with the second payment being paid out after the review of a mid-project progress report.

Your Twinning must have been sanctioned/approved by the WFH and no more than 12 months should have passed if it has been closed by the WFH.

Project must be approved annually by the CHS, its local Chapter / Region (HOT) or HTC Clinic Director and a letter approving the project, signed by the HTC Director or a Board Executive committee officer or a Board resolution, must accompany your proposal.

Your Action Plan for the year of this proposal must be attached to your application.

Please type in your answers in the grey-shaded area next to each question. The grey-shaded area will expand as you type.

Date:Project title:

Name (CHS, Chapter/Region, Hemophilia Treatment Centre):

Supervisor/Primary Contact Person:

Mailing Address:

Tel: Fax:E-mail:

Second Contact Person actively involved:

Mailing Address:

Tel: Fax: E-mail:

Twinning Partner:

Supervisor/Primary Contact Person:

Mailing Address:

Tel: Fax: E-mail:

Second Contact Person actively involved:

Mailing Address:

Tel: Fax: E-mail:

PROJECT DESCRIPTION

In this section (maximum two pages) please outline the rationale behind this project making sure you explain how the proposed activities will be sustainable once the project is finished. Clearly outline your goals, objectives, expected results/outcomes and responsibilities.

DESCRIPTION OF ACTIVITIES

In this section (maximum two pages) please outline the proposed activities and timelines.

BUDGET

Please provide a complete and detailed projected budget for the entire project you are proposing including activities being funded by other sources which should be identified. Also indicate the portion you are requesting from the CHS and what specific budget items will be paid for by the CHS funds. Please note that funding could be renewed for a second year.

PROJECT REPORTING

Please provide a brief (1 page) mid-project progress report outlining progress made to date, obstacles encountered and proposed measures to overcome the obstacles in order to achieve the initial goals, objectives and expected results/outcomes. If you feel some objectives will not be achieved, please explain why and corrective measures you propose to justify the continuation of the project.

MID-PROJECT PROGRESS REPORT

Project title: Project year:

PROJECT REPORTING

Please provide a brief (maximum 3 pages) final narrative and financial report outlining achievements, outcomes/results in relation and in addition to initially expected outcomes/results, obstacles encountered and measures taken to overcome the obstacles.

For the financial report, please list project final actual expenses compared to the projected budget for items which were to be covered by the CHS funds and explain any variances.

Please retain your financial report with all original receipts for all expenses for seven years for audit purposes.

Also, please provide complete and detailed budget results (income and expenses) for the entire project as compared to your proposed budget in your initial application which could have included funding from other sources.