Project Inspire 2015 Application Form Please Note: This form is for reference only. Complete applications must be submitted via the application page on the Project Inspire website (www.projinspire.com) Contact Information Salutation *First Name *Last Name Preferred Name *Address Line 1 Address Line 2 *City *Country *State *Postal Code *Telephone *E-‐mail Address Organization Information *Legal Name *Address Line 1 *City *Country *Telephone *E-‐mail Address *Website Address *Brief description about your organisation *Size of organization (Number of fulltime employees) *Type of organization Non-‐profit/ NGO/ For-‐profit/ Business/ Social Enterpise/ Other (Please State) Questions? Contact Us! E: contact@5minutestochangetheworld.org W: www.projinspire.com Project Inspire 2015 Application Form Please Note: This form is for reference only. Complete applications must be submitted via the application page on the Project Inspire website (www.projinspire.com) *Please list the top 5 funders & amounts to your organization for the past year Organisation Social Media Facebook URL Twitter URL Google + URL YouTube URL Vimeo URL Instagram URL Other URL General Proposal Information *Project/Program Title * In less than 500 words, tell us what your project is going to do with USD$25,000? Results *What problem are you solving? *What sector do you operate in? Education/ Environment & Sustainability/ Science & Technology/ Health/ Entrepreneurship & Business/ Other Questions? Contact Us! E: contact@5minutestochangetheworld.org W: www.projinspire.com Project Inspire 2015 Application Form Please Note: This form is for reference only. Complete applications must be submitted via the application page on the Project Inspire website (www.projinspire.com) (Please State) *Result Statement Your result statement must detail a deadline, have quantifiable goals, and be specific. Example: By December 2015 we aim to educate 150 girls with our training program. It is expected that 50 of those girls will go on to develop small businesses or pursue further specialised education. *How many women and/or girls will you directly impact with your program? *How many women and/or girls will you indirectly impact with your program? *Long-‐term Impact Please state the impact your project will have on the community within the next 3 years *Short-‐term Impact Please state the impact your project will have on the community by the end of the grant period Success Verification * What project results are you committed to achieving? Questions? Contact Us! E: contact@5minutestochangetheworld.org W: www.projinspire.com Project Inspire 2015 Application Form Please Note: This form is for reference only. Complete applications must be submitted via the application page on the Project Inspire website (www.projinspire.com) * What information or evidence will you use to verify your success? Team Details *Other Committed Funders for your project *Project Leader Please detail full name; date of birth; email address; and short biography [Please note: project leaders will be the main point of contact & if successful, will be the representative invited to Grand Finals] *Project Team Please detail full name; role in project and email address *Partners or Intermediaries Please detail any other third party partners who will be involved in your project. Supporting Documentation (Please prepare the following documents for submission) *Budget Upload Please upload your planned budget for your project. *Audited Financial Statements These statements will be for your organization Questions? Contact Us! E: contact@5minutestochangetheworld.org W: www.projinspire.com Project Inspire 2015 Application Form Please Note: This form is for reference only. Complete applications must be submitted via the application page on the Project Inspire website (www.projinspire.com) *Annual Report This will be for your organization * Any other supporting documents *Link to Video Entry * How did you hear about Project Inspire? Questions? Contact Us! E: contact@5minutestochangetheworld.org W: www.projinspire.com