U.S. DEPARTMENT OF STATE
U.S. EMBASSY COLOMBO PUBLIC AFFAIRS SECTION
PUBLIC DIPLOMACY GRANTS PROGRAM
GRANT AWARD AMOUNTS: $1,000 TO $9,900
APPLICATION FORM
Introduction:
All questions aremandatory and must be provided for the proposal to be reviewed.
Please e-mail your completed proposal to before October1, 2016.
Proposals will only be accepted as a Microsoft Word Document, in this template, in English, via e-mail, with the required supporting documents.
PROJECT CONTACT INFORMATION*Organization Name:
*Type (Please Select):
Registered Non-Governmental Organization
Registered Non-Governmental Youth Organization
Registered as NGO and also separately as Limited Liability Company
* Name of primary contact person (Last, First):
* Age of primary contact person:
Affiliation with/Position at Organization:
*Email Address:
Organization Website:
*Telephone:
*Mobile Phone:
Fax:
*Address:
*City/Town/Village:
Postal Code:
Country (Sri Lanka or Maldives)
*Year & Month Organization Established
PROJECT SUMMARY
Summarize the project, answering six main questions: what, how, why, what, where, and what the results will be.
ORGANIZATIONAL PROFILE
Describe the Organization, Staff,and its Capacity to implement the project. If an Implementing Partner will be used, details must be provided.
CURRENT AND PAST FUNDING FOR THE LAST FIVE YEARS.
List all grants, source (donor), year received, and amount. If you have received grant(s) from the U.S. Embassy (including USAID), provide the grant number(s).
PROJECT DETAILS
Explain why the Project is needed and what is the goal of the project:
Describe the Target Group(s)/Beneficiaries:
Describe if the Project is unique or incorporates innovative approaches, ideas, or technologies.
Describe how project outcomes can be sustained after the project is completed.
IMPLEMENTATION
Describe the project activities and provide a timeline for each.
Activity / Timeline by Month
MONITORING AND EVALUATION PLAN
Describe how the activities (listed above) will be monitored to verify that the project isbeing implemented as planned, and ultimately has achieved its impact. What are the measurable outcomes?
REQUIRED ATTACHMENTS
The following documents must be submitted with your proposal:
☐Budget, using the template provided on the NOFO website announcement
☐ Registration Certificate: proof of registration under the appropriate government agencies
☐ Official Permission Letters: Official permission letters from the relevant authorities to carry out the project must be obtained ifneeded for project activities.
☐ Bio-data of Key Personnel: CVs or biographies of any personnel cited in budget, including trainers, implementing partners, or sub-contractors.
☐MOUs/Agreements: with any sub-contractors, implementing partners, etc. involved in the project.
☐ Letters of Support: from any partners, sub-contractors, etc.involved in the project.