UNODC Victim Empowerment Grant Application Form file · Web viewPROJECT PROPOSAL. BACKGROUND. Name of ... of project implementation Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo

European Union

Victim Empowerment Project Grants for CSOs Providing Direct Services to Victims of Crime and Violence Application Form

(VEP.1.2.13.11.2009)

Title of Project

Province of Implementation

District where CSO is based

Total Number of Months for proposed Grant

Total Amount Requested (ZAR)

I. ADMINSTRATIVE DETAILS

Full Legal Name of Organisation Acronym

Physical Address

Postal Address

Contact Person (including job title)

([ ]) ([ ]) ([ ])Telephone Number Fax Number Cell Phone Number

Email Address Alternate Contact Person and Email Address

II. AGENCY STRUCTURE

Type of Organization

International NGO National NGO

Academic Affiliated Institution

Community Based Organisation

Faith Based Organisation Other (specify)

Date when the Organisation was Founded Date when the Organisation was Registered

dd/mm/yyyy dd/mm/yyyyRegistered as:

NPO Trust Section 21 Other (indicate)Registration Number

List of Governing Board Members (add more rows, if necessary)

Name Position Held ID Number Contact Telephone Number and Email Address

VEP2009.1.2.13.11.2009.Application Form 1

European Union

Profile of Staff Working for the Organisation (add more rows if necessary)

Name Full-time/Part-time/Volunteer

Position/Title Years with Organisation

Formal Networks and/or Partnerships (add more rows, if necessary)Partner Organisation Type of Organisation Years of

Involvement

III. ORGANISATIONAL PROFILE AND CAPACITY

Organisation’s Mission Statement/Objective

List the three main activities of the agency

1.

2.

3.List ALL projects currently implemented and all implemented during 2006-2008 (add more lines if required)

From-To(mm/yy)

Project Title Sector(s) Project Location(town, district, province)

Donor (s) inc. contact name, telephone and email address

Total budget expenditure

What was the organisation’s total annual expenditure in the last financial year? (in ZAR)


European Union

____ __RAND

Is your organisation a recipient of DSD funding? Yes NoIf so, how much?1

In 2008, RANDIn 2009, RAND

IV. BANKING AND FINANCIAL DETAILS

Account Name

Account Number

Type of Account

Full Name of Bank

Branch Name

Branch Code

Branch Address

SWIFT Code

Three Account Signatories (REQUIRED)

Name Designation Contact Details (telephone and email)

1.

2.

3.

Grants for CSOs Providing Direct Services to Victims of Crime and Violence PROJECT PROPOSAL

I. BACKGROUNDName of Organisation Submitting Application

Title of Project

Proposed duration of project (in months)

Total Amount Requested in ZAR

Proposed Start Date: (dd/mm/yy) 01 March 2010 Proposed End Date: (dd/mm/yy) 31 December 2010

ESTIMATED BENEFICIARIES

Are the target beneficiaries for this project victims of crime and violence? Yes No___________ Estimated total number of victims of crime and violence directly assisted through this projectEstimated breakdown of beneficiaries___ Women Youth

(females 18-35) Children (female) Older persons

(female) Persons with Disabilities (male)

______ Men Youth (males 18-35)

Children (male) Older persons (male)

Persons with Disabilities (female)

SECTOR SERVICE TYPE

1.


European Union

Sector specialization of this project. Check a maximum of three sectors. Select all that apply

Gender Based Violence Domestic Violence Sexual Violence Child Abuse Psycho-social

Assistance/Counseling Perpetrator

Interventions

Trafficking in Persons Child Headed

Households/Vulnerable Children

Shelter Services Child and Youth Centres Restorative Justice HIV/AIDS

Societal Reintegration Xenophobia Health Legal AssistanceIncome

Generation/Skills Development

Other (please specify)

Direct Assistance to Victims of Crime and Violence

Capacity Building Research Advocacy Training

LOCATIONCheck province(s) of project implementation

Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga Northern Cape North-West Western Cape

List specific districts of programme activities:

List specific cities or towns of programme activities:

Target area(s) are: Rural Peri-urban Urban

Are activities targeting previously disadvantaged groups? Yes No Describe?

ADDITIONAL INFORMATIONIs this proposal or a very similar proposal being submitted to other donors for their consideration? If yes, whom?

Yes No

II. PROJECT DETAILSProject Summary (A general overview the project and activities, in less than 100 words)

Problem Analysis/Rationale for project (Explain the problem and how/why you are seeking to address it, in less than 250 words.)

Overall Objective of project (What is the main purpose/goal you seek to attain with this project, in less than 50 words?)

Project Description (Provide a detailed description of project outcomes, outputs and activities, in less than 500 words, as detailed in the logframe on page 6.)

Monitoring, Evaluation and Learning Plan (M&EL Plan) (Detail your M&EL plan including a description of mechanisms for beneficiary feedback, in less than 100 words)

UNODC is committed to staff development within implementing organizations. Detail how you will increase the technical and/or programme administrative skills of staff in your organization, in less than 100 words.


European Union

UNODC is committed to promoting engagement between government and civil society. Describe how your organization will promote partnership and/or the exchange of information with government institutions, including involvement in local forums,in less than 100 words.

Partnership/Mentoring Plan (If application is for a partnership, provide a clear plan for how your organisation will implement the project as a partnership, including roles and responsibilities. If application is for a mentorship, please describe how you will increase the capacity of your emerging partner organization(s) and how you will effectively monitor progress, in less than 100 words.

Analysis of potential risks and how you intend to counter those risks (Detail any potential risks that could affect the effective implementation of the project, in less than 100 words.)

Sustainability Plan (Detail how you will make these activities sustainable after the completion of the project and any multiplier effect the project could have, in less than 100 words.)

Describe how your proposal meets with relevant victim empowerment policy (i.e. Victims Charter, Minimum Standards on Services for Victims of Crime, Shelter Strategy etc. (Please refer to relevant policy document(s), in less than 150 words.)

Visibility Plan (Details how you will promote the visibility of the UN Office on Drugs and Crime, European Union and Department of Social Development, in less than 100 words.)


European Union

III. LOGFRAME (please copy if more outcomes needed). Based on the general information provided in the Project Description Section, please state each expected outcome and the activities required to achieve this outcome.

OBJECTIVE

Outcome 1:Output Activity Indicator Means of Verification1.11.2



The following three outcomes as OBLIGATORY. Therefore you must complete them and include them in your proposal. The fourth outcome is applicable only in cases on partnerships and mentorships.

Obligatory Outcome 1: Effective monitoring and evaluation of project activities, for a cost not exceeding ZAR XXX.Output Activity Indicator Means of Verification1.1

Obligatory Outcome 2: Enhanced staff capacity to manage and implement project activities, for a cost not exceeding ZAR XXX.Output Activity Indicator Means of Verification2.1

Obligatory Outcome 3: Effective exchange of information / communication with government, for a cost not exceeding ZAR XXX.Output Activity Indicator Means of Verification3.1


European Union

IV. BUDGET (Please add rows and details as necessary. Please be as detailed and precise as possible. Please breakdown the total budget into proposed expenditure per quarter. Please note that you have the option of completing the document in MS word format below or in MS Excel which is also attached.

EXPENDITURES UnitDescrip-

tion(A/B)

No of

Units (A)

No of Units

(B)

Cost per

Unit (in

RAND)

Total Cost

(in RAND)

% of Total

Cost to be

charged to

project

TOTAL AMOUNT

REQUESTED IN RAND

EXPENDITURE 2010

Q1:2010Mar-May

Q2:2010June-Aug

Q3:2010Sept - Nov

Q4:2010Dec

ADMINISTRATIVE COSTS FOR ADMIN COSTS ONLY

1. Operational Staff (administrators, finance, logistics)

Person/month

1.1 List each staff member Indicate what percentage of their total salary will be charged to the project1.21.3SUBTOTAL Operational Staff2. Transport (car rent, kilometer claim)

Contract/month

2.12.2SUBTOTAL Transport3. Public Transport (taxi, plane or bus tickets etc)

Person/#trips

3.13.23.3


European Union

SUBTOTAL Public Transport4. Office expenditures (rent, electricity, water etc)

# of offices/mo

nth,

4.14.24.34.44.5SUBTOTAL Office Expenditures5. Office furniture and technical equipment

piece

5.1 5.2SUBTOTAL Office furniture and technical equipment6. Communications (internet, telephone postage)

Recharge/person/

month or fee per

person per month

6.16.26.3

SUBTOTAL Communications7. Other Costs


European Union

SUBTOTAL Other CostsSUBTOTAL ADMINISTRATIVE COSTS

PROGRAMMATIC COSTSOUTCOME 1 100%Output 1.1 100%

Output 1.2 100%SUBTOTAL Outcome 1 100%OUTCOME 2 100%Output 2.1 100%Output 2. 2 100%SUBTOTAL Outcome 2 100%OBLIGATORY OUTCOME 1: M&E

100%

Output 1.1 100%Output 1.2 100%SUBTOTAL Obligatory Outcome 2: Staff Development

100%

OBLIGATORY OUTCOME 2 100%Output 2.1 100%SUBTOTAL Obligatory Outcome 2

100%

OBLIGATORY OUTCOME 3 100%Output 3.1 100%SUBTOTAL Obligatory Outcome 3: Exchange of info with government/CSOs

100%

SUBTOTAL PROGRAMMATIC 100%


European Union

COSTSTOTAL PROJECT COST


European Union

V. WORK PLAN (Shade each area and include target numbers for each quarter to measure achievements against performance indicators per quarter per line item. Please add more rows as necessary. Include all outcomes and outputs, exactly as they are written in the logframe and the budget.

PROPOSED PERFORMANCE TARGETS 2010Qtr 1: Mar-May Qtr 2: Jun-Aug Qtr 3: Sept-Nov Qtr 4: Dec

OUTCOME 1 Output 1.1 Output 1.2 Output 1.3.OUTCOME 2Output 2.1Output 2.2OBLIGATORY OUTCOME 1: M&EOutput 1.1OBLIGATORY OUTCOME 2: Internal Staff DevelopmentOBLIGATORY OUTCOME 3: Exchange of Information with Government

11

European Union

VI. ChecklistBefore signing and sending the application form, please check that your application is complete as follows:

Application is in English, type written using the approved grant application form (or neatly handwritten).ALL sections of the grant application are complete and those sections or spaces that are not applicable have been marked “NA”.

Signed grant application, including proposal, budget and work plan (all sections complete). Using this VEP2009.1.1.31.03.09.Application Form

Certificate of NPO registrationLast financial year’s audited financial statement and/or certified annual financial report (for newly

registered CSOs who have not yet been registered long enough to be required to demonstrate NPO compliance, six months of bank statements are submitted).

CVs of Project Manager and any other key staffOrganogram (a diagram of your organizational structure) Annex A: Certificate of Financial IntegrityAnnual report (if possible)Pamphlets and brochures (if possible)

Organisation meets all criteria below. South African Non-Governmental Organizations, Community Based Organisations or Faith Based Organisations Be a non-profit making legal entityBe registered with NPO Demonstrates compliance with registration requirements i.e. NPO registered CSOs must be able to demonstrate that the submitted annual reports to DSD NPO Directorate each year since registrationHave a headquarters in South Africa Have representation and implementation capacity in target area(s)Have an active decision making body, such as a board of directors or executive committee Be directly responsible for the preparation and management of the action, not acting as an intermediaryBe able to provide proof of sound financial practises, i.e. audited financial statements

Organisation has previously implemented a project aimed at assisting victims of crime and violence

Target beneficiaries of the project are victims of crime and violence.

CSO is based in rural locations and/or in marginalized peri-urban and urban locations and/or underrepresented districtsCSO is only proposing project activities in one province, the province they are based in.The proposed grant is of a duration of 10 months or less, with a start date of March 1, 2010 and an end date of December 31, 2010. Amount requested is not over 350,000 ZARI am submitting four originals of the complete application. Two originals were sent to UNODC Pretoria c/o VEP Grants Manager and two originals were submitted to my respective UNODC VEP Provincial Coordinator.

NOTE: Please read and complete this form with all due care. Omissions cannot be rectified and if any required information or documentation is missing, your application may be rejected.

12

European Union

VII. Declaration

I, the undersigned, being the person responsible in the applicant organisation for the action, certify that the information given in this application is correct.

Name:

Position:

Signature:

Date and place:

13

Documents

UNODC Victim Empowerment Grant Application Form file · Web viewPROJECT PROPOSAL. BACKGROUND. Name of ... of project implementation Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo