Japan Water Forum Fund2013 Application#2013-
APPLICATION FORM [A]
About your organization (Max. 2-page)
- Name of your organization:
- Brief description of your organization:
(Max. 150-word)
*Give a brief, clear and short explanation of your organization.
- Representative of your organization
Position: / Name: / E-mail address:
Mr. Ms. Mrs. Dr.
- Contact person of your organization
Position: / Name: / E-mail address:
Mr. Ms. Mrs. Dr.
- General information of your organization
Country: / City:
Postal mailing address:
Telephone: / Fax: / Website:
Q1. How many staff member? / Q2.Established year and month?
XX (persons) / XX/XXXX (month/year)
Q3. What kind of projects did you implement in recent years?
（Max. 150 –word）
*Give a brief, clear and short explanation of your past project and itspartners/donors/stakeholders.
- Pictures about your organization
Please paste a picture which was taken from outside and inside your office. *example(JWF)
Outside your office > / <Inside your office>
APPLICATION FORM [B]
Description of your project (Max.3-page)
*Please read all the requirements before starting to fill this application
- Description of water & sanitation problems of your local area with photos which you are trying to resolve with the help of grants from JWF fund. (Max. 200-word):
- Description of your project plan for resolving these water & sanitation problems mentioned in Q1 with the help of grants from JWF fund:
- Project Name (Max. 20-word):
*Give a brief, clear and short name which describes your project, e.g. “Construct 20 eco-san toilets at 5 schools, and holding of 3 eco-san workshops”.
2-2.Project location (Max. 50-word):
*Paste the map and photos of your project’s location here.
2-3.Objectives of your project (Max. 100-word):
*Give a brief and clear description of your project’s objectives.
2-4.Details of your project(Max. 300-word):
*Give a more in depth description of your project.
*Clarify numbers: If you plan to construct wells/toilets/rain-harvest tanks and so on, e.g. construct wells:4, construct toilets: 5, built rain-harvest tanks: 3 and water & sanitation Workshops: 3 times.
*If your project is related to a well for drinking water, describe how you check water qualities.
2-5.Prospective positive impact of your project on these water & sanitation problems mentioned Q1 (Max. 100-word):
2-6.Number of direct beneficiaries of your project(Max. 50-word):
*Total expected number (men/women/children) of direct beneficiaries of your project should be described.
2-7.Stakeholder participation (Max. 100-word):
*The contribution of all types of stakeholders who participated in planning and implementing your project should be clearly described.
2-8.Sustainability and Expandability(Max. 150-word):
*The plans for sustaining your project in time should be clearly described.
2-9.Schedule(Max. 100-word):
*The schedule of your project should be clearly described.
*The recipients must implement the project by March 31, 2014.
- Have you ever applied JWF Fund before?
Yes / No If your answer is yes, please indicate the year:
- Have you ever received a JWF Fund before?
Yes / No If your answer is yes, please indicate the year:
APPLICATION FORM [C]
Cost of your project
* This budget chart must be filled in US$
Total cost of completing your project: (US$）
Amount request to the JWF fund: (US$）(up to 1,000US$)
Item / Content / Unit cost(US$) / Quantity / Amount(US$)Local contribution if any
Amount request to the JWF fund
(up to 1,000US$)
Total cost of completing your project
APPLICATION FORM [D]
Other information
- Which currency bank account does your organization have?
US$ / EUR / YEN / Local currency ( )
- Remittance information: *Please ask your bank if you do not know these detail information.
Account Name:
Address of Account Holder:
Country:
Bank Name:
Branch Name:
Account No./IBAN Code:
Address of Bank:
Country:
[Through]
SWIFT Code:
- Even though the grant is (up to) 1,000 US$, the net amount you will finally receive on your bank account may be lower, due to bank charges, transfer charges, etc. Do you agree with it? *Please note that the JWF does not cover any remittance charges. Yes / No
- Do you agree that you will submit a report following the “JWF Fund Report” format, with some related pictures and the actual expenditure shown on an attached table by April 10, 2014 if you are selected as a recipient of a grant from the JWF Fund 2013?
*Please note that recipients of a grant from the JWF Fund must submit the report on the use of the grant.
* Submitting the report is absolutely necessary:
- Donors need evidence the grant is used properly
- Other potential donors will access to the project report and gain awareness of your activities
- If you don’t submit the report, you will be ineligible for any future grant from us and our partners
Yes, we will submit the report by April 10, 2014.
- Do you agree that your report including pictures will be used under the name of the Japan Water Forum?
Yes, we agree that our report including pictures will be used under the name of the Japan Water Forum.
- Do you agree that you will participate in the follow-up surveys of JWF Fund occasionally?
Yes, we will participate in the follow-up surveys of JWF Fund.
Please note: The name of your organization, the name of your project as well as the result will be published on the Japan Water Forum web site. Also, pictures you provide to JWF will be used under the name of JWF.
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