NOT FOR SALE ANTI-CHILD TRAFFICKING PROGRAM PARTNER APPLICATION Please complete the following proposal for 2015 project funding 1. APPLICANT DETAILS Please provide the following: 1.1 Organization Name (officially registered name) 1.2 Executive Director (full name) 1.3 Primary Contact Person (full name) 1.4 Organization Address(es) Please provide the addresses for all project sites 1.5 Email Address(es) Please provide the email addresses for the following individuals 1.5.1 Executive Director 1.5.2 Primary Contact 1.6 Telephone 1.7 Fax 1.8 Website Address 2. BACKGROUND INFORMATION Please describe the following: 2.1 Mission Describe the organization’s mission (max 200 words) 2.2 History Please describe the organization’s history, including the number of years’ experience providing services to survivors of human trafficking or individuals meeting Not For Sale criteria for “at-risk” (max 400 words) 2.3 Target Population Please describe the target population served by the organization, including gender, age, nationality, ethnicity etc. (max 200 words) 2.4 Main Activities Please describe the organization’s main activities (max 400 words) 2.5 Impact to Date. Briefly describe the organization’s impact to date (max 400 words) 2.6 Financial Stability 2.6.1 Please describe any income generating program activities that support the financial sustainability of the organization e.g. selling products or providing services that return income to the program (max 200 words) 2.6.2 What portion of the organization’s annual operating budget is covered by these income generating activities? 3. GOVERNANCE Please describe the following: 3.1 Leadership and Staffing 3.1.1 Describe your leadership, staff, members, and their roles in decision-making, and the organization’s decision-making process (max 300 words) 3.2.1 Provide brief biographical information about your key staff. Please include the number of years and a description of relevant professional experience delivering programs to survivors of human trafficking or individuals meeting Not For Sale criteria for “at-risk” (max 300 words) 3.2.2 Are all employees paid at or above national industry average, and does your organization offer paid and unpaid time off, in accordance with national standards? 3.3 Board of Directors 3.3.1 Please provide a list of names of the organization’s Board of Directors and job titles 3.3.3 How many are foreign Board members? 4. FINANCES Please provide the following: 4.1 Total annual operating budget 4.2 Accounting 4.2.1 Describe the organization’s accounting processes and the individuals involved (max 300 words) 4.2.2 Does the organization have experience in international accounting standards? 4.2.3 Does your organization complete an annual financial audit? 4.3 Funding Sources. Please provide a breakdown and describe the main sources of funding for your organization (max 300 words) 5. PROGRAM DETAILS Please provide the following: 5.1 Program Title 5.2 Program Budget (total operating budget) 5.3 Geographic Region Served (max 200 words) 5.4 Problem to be Addressed (max 200 words) 5.5 Program Description (max 500 words) 5.6 Target Beneficiaries 5.6.1 Describe the persons who will directly benefit, including number, age group, gender, nationality, ethnicity etc (max 300 words) 5.6.2 Describe the persons who will indirectly benefit, including number, age group, gender, nationality, ethnicity etc (max 300 words) 5.7 Program Impact (Grant Period: July - December 2016) 5.7.1 Program Goal(s) 5.7.2 Program Activities 5.7.3 Program Outputs 5.7.4 Program Outcomes 5.8 Risk Analysis 5.4.1 What are the risks identified by the organization to successful completion of the program? (max 300 words) 5.4.2 How does the organization minimize the identified risks? (max 300 words) 5.4.3 What are the risks that the intervention will not be implemented as planned? (max 300 words) 6. BUDGET Please attach a line-item budget detailing the annual cost for the proposed program. Please use the following categories listed for all expenses, and include notes to describe the items listed): Program Expenses Salaries Marketing Expense Facilities Expense Telco Office & Admin Expense Travel & Entertainment Professional Services & Consultants Employee Development 7. GRANT MANAGEMENT 7.1 Program Manager 7.1.1 Please provide a resume and contact details for the Program Manager who will be overseeing the grant. 7.1.2 Can the Project Manager speak and write English? If yes, who else aside from the Project Manager speaks and writes in English? 7.2 Program Staff 6.2.1 Proposed program staff positions and their duties relative to the overall implementation of the program (max 500 words) 7.3 Monitoring and Evaluation 7.3.1 Describe the average period of care for program beneficiaries 7.3.2 What is the length of follow up/ care for beneficiaries exiting the program? 7.3.3 Please describe the organization’s case management system, and the information collected about program beneficiaries (max 500 words) 7.3.4 Please describe the organization’s process for tracking beneficiary progress through the program (max 500 words) 8. BANK DETAILS 8.1 Please provide the organization’s bank account details AUTHORIZATION Please sign below to confirm that the information contained in this form and in any supplementary paperwork or information is accurate. Once signed, please send the completed application to Hannah Darnton at hannah@notforsalecampaign.org. Please note that any misleading or fraudulent information supplied in this Partner Application form will result in the immediate return of all grant monies and possible legal action against the applicant. Date: Project: Total Grant Amount Requested (not including additional projects): Signed: Position: For and on Behalf of:
© Copyright 2024