ROTARY DISTRICT 5100
GLOBAL GRANT 2014-15APPLICATION WORKSHEET
for a
VOCATIONAL TRAINING TEAM
All information in this application worksheet must be complete in order for your project to be considered for a District Global Grant DDF allocation. Please type in the form and then e-mail it to Global Grant Chair Christine Huot at .
INTERNATIONAL SPONSOR
District: 5100
Primary Contact Click here to enter text.
Contact E-mail Click here to enter text.
Contact Phone Number Click here to enter text.
Club Click here to enter text.
HOST SPONSOR
District Click here to enter text.
Primary Contact Click here to enter text.
Contact E-mail Click here to enter text.
Contact Phone Number Click here to enter text.
Club Click here to enter text.
Will this VTT include another Global Grant? (Check any that apply)
☐Humanitarian Project ☐ Scholarship
Where will your project take place?
Community Click here to enter text.
City or Village Click here to enter text.
Country Click here to enter text.
Project Summary. Describe the objectives for this project or training:
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Who will benefit from this Global Grant? List the approximate number of direct beneficiaries.
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Describe the benefiting community, including its location using any relevant geographic and demographic information:
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Outline your Project Implementation Schedule:
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TEAM NAMEClick here to enter text.
Team is:☐ Providing Training☐ Receiving Training
When do you anticipate your training will take place?
Estimated Date of Departure Click here to enter a date.
Estimated Date of Return Click here to enter a date.
What training needs will the team(s) address and how were these needs identified? Provide any relevant data or survey results?
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Detail the specific objectives for the training, including expected positive changes in recipient knowledge, abilities, and/or skills.
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How were members of the local community involved in planning the training? Does the training align with any current or ongoing local initiatives?
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How will you support training recipients so that skills received through training are kept up-to-date?
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VOCATIONAL TRAINING TEAM
Vocational training teams are groups of professionals traveling abroad to either learn about their profession or teach local professionals about a particular field.
Provide contact information for your vocational training team members. Each team member will receive an email notification from Rotary with instructions to log in, view this grant application, and complete their profiles.
Role / Name / E-Mail / If Rotarian/Club1 / Click here to enter text. / Click here to enter text. / Click here to enter text.
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AREAS OF FOCUS: Please check the applicable Area(s) of Focusand descriptions:
☐Peace and conflict prevention/resolution
☐Training leaders, including potential youth leaders, to prevent & mediate conflict
☐Supporting peace-building in communities and regions affected by conflict
☐Supporting studies for career-minded professionals related to peace and conflict prevention/res. ☐Disease prevention and treatment
☐Improving the capacity of local health care professionals
☐Promoting disease prevention programs, with the goal of limiting the spread of communicable diseases
☐Enhancing the health infrastructure of local communities
☐Educating and mobilizing communities to help prevent the spread of major diseases
☐Preventing physical disability resulting from disease or injury
☐Supporting studies for career-minded professionals related to disease prevention and treatment
☐Water and sanitation
☐Providing equitable community access to safe water, improved sanitation and hygiene
☐Strengthening the ability of communities to develop, fund & maintain sustainable water/sanitation systems
☐Supporting programs that enhance communities' awareness of the benefits of safe water & sanitation
☐Supporting studies for career-minded professionals related to water and sanitation
☐Maternal and child health
☐Reducing the mortality and morbidity rate for children under the age of five
☐Reducing the maternal mortality and morbidity rate
☐Improving access to essential medical services and healthcare providers for mothers and children
☐Supporting studies for career-minded professionals related to maternal and child health
☐Basic education and literacy
☐Involving the community to support programs that provide basic education literacy to all
☐Increasing adult literacy in communities
☐Working to reduce gender disparity in education
☐Supporting studies for career-minded professionals related to basic education and literacy
☐Economic and community development
☐Building the capacity of community networks to support economic development in poor communities
☐Developing opportunities for productive work
☐Reducing poverty in underserved communities
☐Supporting studies for career-minded professionals related to economic community development
How will you meet the Area(s) of Focus goals:
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Who will be responsible for collecting information for monitoring and evaluation?
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How will you measure your impact? Note that Global Grant sponsors of approved applications will be expected to account for the total number of direct beneficiaries in the final report.
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Briefly explain howyou will promote Rotary awareness with the project.
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Rotary Club Project Committee
A committee of at least three Rotarians must be established in the sponsoring Club. It is the committee's responsibility to coordinate the project locally, monitor funds, and provide financial accounting in accordance with the “Terms and Conditions” of this agreement for the duration of the project.
Primary Contact / Member / MemberName / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Rotary Position / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Preferred Phone / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Email Address / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Partner Club Committee
A committee of at least three Rotarians must be established in the partner Club. It is the committee's responsibility to coordinate the project locally, monitor funds, and provide financial accounting t in accordance with the “Terms and Conditions” of this agreement for the duration of the project. Official communication will be with the Primary Contact.
Primary Contact / Member / MemberName / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Rotary Position / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Preferred Phone / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Email Address / Click here to enter text. / Click here to enter text. / Click here to enter text. /
Conflict of Interest
No Rotarian who has a vested interest in the activity (e.g., an employee or board member of a cooperating organization, owner of a store where project goods will be purchased, Trustee of a university that a scholar plans to attend) may serve on the grant committee.
If any potential conflict of interest exists, disclose it here:
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COOPERATING ORGANIZATION
Cooperating organizations are reputable non-Rotary organizations or academic institutions that provide expertise, infrastructure, advocacy, training, education, or other support for the grant. Identify any cooperating organization participating in your project.
NameClick here to enter text.
Website Click here to enter text.
Address Click here to enter text.
City Click here to enter text.
Country Click here to enter text.
Describe your process for selecting this organization. What resources or expertise will this organization contribute? Attach a scanned, signed copy of the Cooperating Organization Memorandum of Understanding
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PARTNERS
List any additional partners who will participate and identify their responsibilities. This may include Rotary clubs, Rotaract clubs, Rotary Community Corps, or individuals.
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VOLUNTEER TRAVELERS
International travel for volunteers is permitted for up to two individuals as part of a humanitarian project. These individuals provide training or implement the project should the host sponsor confirm that their skills are not readily available locally. Identify any Rotarian or non-Rotarian whose international travel will be funded by this global grant. If Rotarian, include club and district.
Name of First Traveler
First NameClick here to enter text. Family Name Click here to enter text.
E-mail Click here to enter text.
Rotary Club Click here to enter text.
Name of Second Traveler
First NameClick here to enter text. Family NameClick here to enter text.
E-mailClick here to enter text.
Rotary ClubClick here to enter text.
RESUME OF EACH VOLUNTEER TRAVELER
Attach a resume or curriculum vitae in PDF form for each volunteer traveler. Scan and attach a daily itinerary in PDF format for the volunteer traveler(s). Include travel, training, and/or project implementation activities.
The host club or district has extended a travel invitation, fully supports and approves volunteer traveler(s), and verifies that the international travel to the club and/or district is needed to implement the project.
☐ Yes ☐ No
ROTARIAN PARTICIPATION
Describe the role of the host Rotarians in this activity and list their specific responsibilities.
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Describe the role of the international Rotarians in this activity and list their specific responsibilities.
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SUSTAINABILITY
Describe the role that members of the local community will play in implementing your project. What incentives (e.g., compensation, awards, certification, promotion) will you provide to encourage local participation?
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Identify any individuals in the local community who will be responsible for monitoring outcomes and ensuring continuity of services. How will you support these individuals to help them take on this leadership role?
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BUDGET:
Budget Details: Note: Exchange Rates can be found at
Date exchange rate entered Click here to enter a date.
Name of local currency Click here to enter text.
Currency/Exchange Rate for $1 Click here to enter text.
Line Item # / Description / Supplier / Cost (local currency)1 / Click here to enter text. / Click here to enter text. / Click here to enter text.
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Budget total in local currency Click here to enter text.
Budget total in USD Click here to enter text.
Attach any supporting documentation such as price bids or pro forma invoices to support the project budget item numbers.
Describe the process for selecting these budget items. Do you plan to purchase any items from local vendors? Have you performed a competitive bidding process to select vendors? Do these budget items align with the local culture and technology standards?
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How will the beneficiaries maintain these items? If applicable, confirm that spare or replacement parts are readily available and that the beneficiaries possess the skills to operate equipment.
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Who will own the items purchased with grant funds at the end of the project, including equipment, assets, and materials? Note that items cannot be owned by a Rotary club or Rotarian.
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FINANCING: Project Financing In US Dollars
Source (e.g. Organization, Rotary Club of……) / Cash Contribution / DDF / TRF MatchClick here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text. /
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FINANCING TOTALS:
Rotarian Cash Amount in USD$ Click here to enter text.
Additional outside funding in US$ Click here to enter text.
District 5100 DDF Amount in US$ Click here to enter text.
Other District DDF Amount in US$ Click here to enter text.
Requested Rotary Foundation (TRF) Match in US$ Click here to enter text.
Total Financing in US$ (Cash+DDF+Match)Click here to enter text.
Have you identified a local funding source to ensure long-term project outcomes? Will you introduce practices to help generate income for ongoing project funding?
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Use of Rotary District 5100 District Designated Funds require a dollar for dollar match from clubs within District 5100.
- The Rotary Foundation will match cash contributions at 50 percent and DDF contributions at 100 percent. The Rotary Foundation will match non-Rotarian contributions to a grant providing they do not come from a cooperating organization or a beneficiary.
- The minimum World Fund request is $15,000. The maximum World Fund request is $200,000
- The total project financing in US Dollars must match the budget in US Dollars
ADDITIONAL INFORMATION
List any additional information you would like the Global Grants Committee to consider in reviewing your grant application
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Club President’s NameClick here to enter text.
Club President’s Signature ______
Date Click here to enter a date.
Primary Contact Signature ______
Date Click here to enter a date.
Global Grant Checklist
☐ Have you completed all of the sections in the Global Grant Application Worksheet?
☐ Have you selected an area of focus?
☐ Is the Rotary Foundation match at least $15,000 and not more than $200,000?
☐ Does the project budget in US dollars match the project financing in US dollars?
☐ If you have a cooperating organization, have you completed and attached the Cooperating Organization MOU?