The Violence Prevention Learning Center
Application for Effective Violence against Women Prevention Course:
Using a Power Analysis to Prevent Violence against Women
Thank you for your interest in becoming a partner and taking one of the courses in our series on Effective Violence against Women Prevention: “Using a Power Analysis to Prevent Violence against Women" held from 13th-15th October 2015 in Harare, Zimbabwe.
To apply, please fill out the following form in its entirety. Incomplete applications will not be considered. Once completed, submit it to no later than 14th September 2015. Please note that only complete applications will be considered. Please note that only short-listed applicants will be contacted by September 19th 2015.
Section One: Organization Profile
Name of Organization:Type of Organization (choose one):
Community-based Organization
National NGO
International NGO
Faith-based Institution
UN Agency
Government Agency
Other/Specify:
- Academic/Research
- Professional Association
-
Organizational Contact information
Physical Address: / PO Box:
Telephone:
Fax:
Email:
Organization’s Website (if any):
Registration number and legal status:
Organization’s Director/ Representative
Name:
Title: / Email:
Phone No:
Organization’s Contact Person (if different from the Director)
Name:
Title: / Email:
Phone No:
Administrative Details
# of program staff at your organization: Women Men
# of staff working on VAW program: __Women _ Men
# of administrative staff at your organization: Women Men
No. of years the organization has been operating:
No. of years (if any) that the organization has worked on VAW prevention:
Names and titles of staff who would participate in the Effective VAW Prevention courses (two staff participants required per organization):
1. Staff Name: Position /Title:
2. Staff Name: Position /Title:
Please explain, why you choose to send these specific staff?
Current Year Annual Budget:
Actual (funds received):
Projected (funds expected):
Current amount of organizational funding earmarked for VAW prevention:
Section Two: Programmatic Information
1. What are your organizations key program areas? (200 words max)
2. Has your organization designed/ implemented VAW prevention activities before? Yes No
-If yes, please describe (250 words max)
-If no, please explain why your organization is interested in doing so at this time? (250 words max)
3. From your organization’s perspective, what is the root cause of VAW? (250 words max)
Section Three: Effective VAW Prevention Courses
4. Please tell us how you intend to use the learning to make adjustments in your programming? (200 words max)
Section Four: Organizational Commitments
1. What are your expectations of this partnership with Raising Voices? (Include perceived benefits, responsibilities, expectations, etc) (200 words max)
2. If selected, is your organization able to designate 2 senior and relevant staff members to come to Harare and be the communication lead for the duration of the partnership? Yes No
3. If selected, is senior management able to participate in an annual skype/phone call to review progress of the partnership and programming? Yes No
Section Five: Supporting Documents
The following supporting documentation is necessary for the application to be considered complete and to be eligible for the course:
A. Proof of NGO registration
B. Current strategic plan/proposal (if available)
Section Six: Course Participation Costs
A limited number of partial scholarships are available for local and national organizations only who demonstrate serious financial need. All organizations are required to contribute something to their participation in the course.
Please tick only ONE box below for Option 1 or Option 2, indicating how your organization will cover the costs of participating in the course. If you select Option 2, please answer all of the questions in that section to be considered for a scholarship.
Option 1: Self-sponsorship
Your organization agrees to cover all related costs in full including:
a. Course fee of $300 per person per course (which covers participant’s accommodation, breakfast, and lunch)
b. Round-trip transportation (bus/air ticket) to/ from Harare
c. Visa fees (if relevant) and airport transfers in your home country
d. Per diem (dinners and incidentals)
e. Additional expenses approved by your organization
*NOTE: all participants are required to stay at the designated hotel, no exceptions.
Option 2: Application for Scholarship
Your organization is applying for one of the few, partial scholarships that are available for local and national organizations that meet the selection criteria and provide a statement of need (see below).
1. What is your organization able to contribute to the cost of the course (please tick all that apply:
Course fee of $300 per person per course (which covers participant’s accommodation, breakfast, and lunch,
Round-trip transportation (bus/air ticket) to/from Harare
Visa fees (if relevant) and airport transfers in your home country
Per diem (dinners and incidentals)
Other (please describe)
2. Please write a statement of need in the space below as to why you/ your management feels your organization should receive this financial support. (350 words max)
Section Seven: Commitment Statement/ Signatures
Organizations accepted will sign a one-year partnership agreement following the course. The partnership agreement details the following mutual commitments. Your organization’s director or senior management is required to review these commitments and indicate their acceptance by signing below.
>Dedicated staff
The organization will identify two staff persons who will be the primary collaborators for the length of the partnership agreement. This includes being (1) the course participants, (2) the primary recipients of technical assistance, and (3) lead the integration of concepts into programs and implementation.
>Full course participation
The identified staff will actively participate in all of the sessions for the course for which they have been accepted.
>Action planning
The organization will develop and implement an action plan for incorporating learning into existing or new programs within two months of course completion.
>Technical assistance
The organization will receive technical assistance for one year after course completion to support the integration of all learning into practice. Technical assistance will be customized to the organization’s program context and specified within the partnership agreement. The organization will avail staff time, organizational support, and resources to technical assistance processes to ensure their relevance and impact.
>Collaboration commitment
Registration and participation in any future Courses at the Violence Prevention Learning Centre will be contingent on adherence to the commitments within the partnership agreements.
I have read and understand the mutual commitments of the partnership and if accepted, will ensure my organization’s adherence to these commitments (to be further outlined in a partnership agreement).
Signed by Organization’s Director/ Senior Management:
______
Name
______
Title
______
Date
Section Eight: Submission Information
Before submitting, please make sure your application is complete by reviewing the following checklist. Have you…
Checked the course deadline to ensure timely submission?
Filled out Sections 1-7 completely?
Obtained a signature from your organization’s Director on the Commitment Statement?
Attached all required documents?
Once your application is complete, please submit this application form along with all required documents to by 14 September 2015.
All applicants will receive an email confirming receipt of their application within two weeks of its submission. Shortlisted applicants only will be contacted by September 19, 2015.
Thank you for your commitment to preventing violence against women!
1 Application Form _ Violence Prevention Learning Center