UNDP GEF/CCF Small Grants Programme

APPLICATION FORM

  (Please fill all the columns in the application form) 

A. Organizational Profile  

1. Name of the Organization:

2. Address and contact details:

 

                        Contact person:

Phone: (O)                               (R)                               Fax:
          E-mail:                                    Website:         

3. Registration details: No. of years; 
   (Please enclose relevant photocopies)

4. Organization details:
a)      Organizational Structure:
b)      Current Annual Budget: 
c)  Total expenditure on the last three projects: ie. Program based and Administrative based.  
d) Details of Current staff and Qualifications: indicate total number and number of professional, administrative and support staff etc. In each category, indicate the number of men and women.
e) Proven in-house experience – evidence (in the science and technological 
Component of the project) that the applicant can successfully implement the project.
f) Demonstrated ability of the institution to mobilize resources from communities.
g) Membership/affiliations to National/ State agencies or institutions.
h) Office infrastructure of the NGO/CBO in the proposed project district/area.
i) Current objectives and major activities undertaken by the NGO. (No More than 300 words).
j) Who have been the partners in projects executed in the last three years: Government/National NGOs/Institutions; International Donors etc. 
h) Relevant project (related to GEF focal areas) implemented in the last 5 years

Sr. No.	Name of Project	Funding Agency & contact person	Project amount	Project duration/present status	Remarks

B. Details of the Project 

A. General 

6. Project Title:

7. Project Budget :

8. Project Location:

             Region/State:               Nearest City:                         

9. Duration:

10. Person responsible for the Project:

B. Project Description  

11 (a) Goal of the project  
    (b) Purpose/Objectives of the project:

12 (a) Project Outputs 
    (b) Major Activities (required to achieve the Project Purpose)
    (c) Time Schedule of activities to be clearly explained through Activity Charts
    (d) Key project Risks

13. Justification for the project (Why do you want to do this project) :

14. Project Strategy to achieve the project purpose:

15. Project Beneficiaries: (who benefits)

16. Role of Communities in the project (both in taking decisions, fund contributions (actual/kind), Ownership, Planning, execution and implementation – not to exceed 150 words.)

17.Global Environment Impact of the project (Explain how this project helps in Conservation of environment in 150 words.)

18. Replicability of the project.

19. Sustainability of the project activities (Mechanisms and How)

20. Scientific and Technical Content (not more than 250 words) 
Scientific and Technical inputs required for the project and mechanisms for the same.

21. Relationship to SGP Thematic Area/Mandate 

22. How does the project demonstrate: Innovation, Participation and Gender Sensitivity and Equity in the proposed project.  

C. Project Impacts 

23.  Project Impact Indicators (to monitor and evaluate progress in activities):

24. Networks/ Links with Government / Line departments / scientific institutions/ academic Institutions, etc. 

25.What impacts it will create in terms of Policy/ Advocacy/ Sustainability/ and Replicability in long term.

26. Media Coverage (Needs to be encouraged and covered during the life of the project) 

27. Project to make contacts. Other development/ environment agencies/ projects using the SGP Approach 

28. Does the proposal require any specific permission? Which are these? Have they been obtained from necessary Central/State/District level governments / Departments / Forest/Institutions? (If yes, please attach relevant documents). 

29. Status of land on which the work is being proposed: Private lands; community land; Forest Deptt; Panchyat and Revenue lands etc. 

D. Budget for the project:  

30. Estimated total project cost: 

31. Suggested format for Budget Break down (Please add heads/subheads/columns as required) 

Sr. No	Components	Amount requested from SGP (Rs.)	Co-financer (Rs)	NGO’s and  Communities contributions (Rs)	Total (Rs.)	% of the total budget
	Years	1      2     3	1    2     3	1    2     3	1    2   3	1  2  3
A.	Project Activities (Please specify and give detailed activity wise break up with unit costs)
B.	Staff Costs
C.	Training, workshops,  Exposure visits & Seminars
D.	Travel Costs
E.	Consultants/ Resource persons
F.	Communications and Admn.
G.	Monitoring & Evaluation
H.	Documentation & Reporting
I.	Any other (please specify)
J.	Contingency ( not more than 2- 5 % of the total project cost)

Note : For contingencies costs, approval needs to be taken from the National Coordinator. Also certify that    
     the SGP component is not being funded through any other source of funding agency. 

E:    Time schedule of Activities  

As explained in point 12 (c) 

   

                                                                                                Signature of the authorized person   
                                                                                                With designation and stamp

 Annexures:

1.      Annual Report

2.      List of key professionals

3.      Registration certificates

4.      Audited financial reports of 3 years

     5.      Any other attachments (if required)