Kenya Community Development Foundation,

4th Floor Morningside Office park - Ngong road,

P.O Box 10501-00100,

Nairobi

Email:

Website:

INSTRUCTIONS

Please read carefully through the attached (enclosed) Guidelines before filling out this grants application form. The Guidelines explain the eligibility criteria, selection process and other important details. In addition, read the short instructions at the top of each section of this application form and do your best to adhere. Be brief and to the point without losing important information or ideas. Answer all questions as best you can. Remember, any incomplete applications will automatically be disqualified. Total submission may not exceed 15 pages (must be typed and in font size 12) excluding the Annexes. Please email your application to before the deadline (10th March 2017) stating the Ref No. KCDF/LECC/P4C/RFP/09/APR2017, in the submission email subject line. Applications delivered outside the deadline are automatically disqualified

This application form has 2 sections:

Section I – Information on the Applicant

Section II – Project Details


This part when filled out should not exceed 3 pages.

  1. Contact Information of applying organization

Name of your organization / Name of contact person
Postal Address / His/her current position
Organization Phone
number / Phone of contact person
Website address (if applicable) / E-mail address
  1. Type of applying organization Please refer to the guidelines

Type of registration (tick as appropriate) / □Self Help Group □ Trust □ Society
□ Community Based Organization
□ Non-Governmental Organization
□ Company Limited by Guarantee
□ Other, please specify ……………………………………….
- Organization is legally registered / □ Yes □ No
-Date of registration (dd/mm/yyyy)
-Registration number
  1. Vision, Mission/structure of the applying organization

Briefly state Vision, Mission and description of your organization and its objectives / Vision:
Mission:
Organizational profile and key objectives .
Key past achievements.

Ref No: KCDF/LECC/P4C/RFP/09/APR2017/Application-Form

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  1. Grants management history

a) Have you received funding before from KCDF before? □ YesNo □

b) If Yes in (b) above;

Year of funding / Grant amount received (in KES) / Intervention supported / Was the project successfully completed?
Yes□ Ongoing □ No □
Yes□ Ongoing □ No □
Yes□ Ongoing □ No □

c) In the table below, provide information of a maximum of 4 past/on-going grants you have managed/are managing as an organization, starting with the most recent.

Name of donor / contact details (Telephone & Email) / Grant amount provided in Cash (KES) / Grant period / Purpose/objective of grant (include beneficiaries reached) / County(ies) targeted
1.
2.
3.
4.

Ref No: KCDF/LECC/P4C/RFP/09/APR2017/Application-Form

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Instruction: This part when filled out should not exceed 2 pages.

  1. Project Title

Proposed short title of your project
  1. In not more than 100 words kindly give a brief of your project
  1. Project Area

In which county, constituency and ward in Kenya is your project going to be implemented?

County / Constituency / Ward
  1. Project Duration

Expected length of your project (max is 18 months). This includes a fund raising window of no more than 6 months
  1. Project Cost
  2. Estimated total project cost in cash - Ksh: ______(An addition of your contribution at 50 % of total project cost and KCDF’s premium or match at 50% of total project cost) Amounts will be disbursed by KCDF)
  3. Your CASH contribution in Kenya shillings: ______(To be locally raised by the applicant. The Applicant will contribute a minimum of 50% of the total project cost. This contribution must be in monetary terms and will be deposited in a KCDF account to be provided subject to approval of your proposal).
  4. Amount requested from KCDF in cash – Ksh: ______(KCDF will match/ pay a premium of 50% to your successful fundraising results above)
  5. Your Target Groups

Targets for KCDF grant: In this section, you are required to indicate the population that you intend to reach through the project for which you have asked KCDF to support.

Type of beneficiary (Mark with an ‘X’ where appropriate) / Number targeted / Type of beneficiary (Mark with an ‘X’ where appropriate) / Number targeted
Households □ / Children (15-17 years old) □
Schools □ / Orphans and Vulnerable Children (OVC) □
Grass-root organizations □ / People with Terminal Illness □
Specify:______
Youth (aged 18 – 35 years) □ / Marginalized and pastoral population □
Women □ / Drug users □
Men □ / Commercial Sex Workers □
Children (0-6 years old) □ / Teachers □
Children (7- 14 years old) □ / Farmers □
How will your proposed project impact on the targeted beneficiaries?

Instruction: This part when filled out should not exceed 3 pages.

  1. Problem definition:

  1. Who are the people targeted by the proposed project in your community?

  1. What issues/challenges/needs do these target groups face which the project will address?

  1. How did you identify these issues and needs?

  1. Project idea:

  1. What is your project idea?
/
  1. How will it address the problem described above?

  1. How will it impact on the target community?

  1. How do you intend to fundraise locally to contribute minimum 50% of the cost of implementing this project idea?

  1. How shall your project engage with government at different levels?

  1. Project objectives

a. What would your project achieve? / State the main objective/goal of the project:
b. What concrete results (specific objectives) would it have? Please list 3-4 key measurable results: / Result 1:
Result 2:
Result 3:
Result 4:
  1. Implementation:

What specific steps/activities would be taken to implement the project? List at least five main steps in chronological order: / Step 1:
Step 2:
Step 3:
Step 4:
Step 5:
  1. Innovation:

How is your project truly innovative and unique in your context?
  1. Monitoring - What are the indicators you intend to use to measure the success in implementation of planned activities? (Match your indicators with the activities presented in section 14)
  1. Evaluation – What are the indicators you intend to use to measure the outcomes of your intervention? (Match your indicators with the results presented in section 13)
  1. Sustainability – What strategies will you put in place to ensure that the benefits of this project continue to be felt beyond the period of KCDF support?
  1. Risks - What are the main risks associated with the proposed project and how will you mitigate them? List at least 2.
  1. Reliability and Scaling-up – What is the possibility of implementing your project elsewhere and what is the potential for this project to be expanded on a larger scale?

Ref No: KCDF/LECC/P4C/RFP/09/APR2017/Application-Form

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Outcome Objectives / Planned Outputs / Activities / Indicators / Means of verification / Timeframe
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21

Ref No: KCDF/LECC/P4C/RFP/09/APR2017/Application-Form

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Ref No: KCDF/LECC/P4C/RFP/09/APR2017/Application-Form

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Please provide all the following documents.

  1. Copy of registration certificate
  2. A copy of organizational constitution or Articles of Association.
  3. A list of; ordinary members and committee members (if a SHG), board members (if a CBO/NGO/FBO/PSO), trustees (if a Trust), board members and trustees (if a Foundation).
  4. Your most recent financial report (must be from a certified auditor if applying organization is an NGO, FBO, PSO or foundation)

Ref No: KCDF/LECC/P4C/RFP/09/APR2017/Application-Form

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