Application Form - Eng
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APPLICATION FORM A. ORGANISATIONAL INFORMATION 1. Name of organisation: 2. Title of project: 3. Address: 4. Full name of person responsible for the project:: 5. Tel/fax, e-mail, mob. of person responsible : 6. Why does your organisation exist and what are its aims?
B. PROJECT DESCRIPTION 1. Project summary – briefly describe (in no more than 150 words)
2. Underline one the fields within which your project falls: 1. peace-building and reconciliation 2. ecumenical and inter-religious cooperation 3. gender advancement
3. Describe the problem your project seeks to address. How was this problem identified and whom does it affect? 4. Briefly describe the social, economic and political context in which the project will be implemented.
Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
C. PROJECT IMPLEMENTATION 1. Activities a. Location: b. Timeframe: c. List the activities chronologically and person responsible for each of the planned activities. (Describe each activity in detail and where needed please extend the table).
Activity
Time of implementation
no.
Location
(date & duration of each activity)
Project personnel/ name of trainer
1. 2. 3.
Description of each activity: 1. 2. 3.
2. Beneficiary group a. Describe the beneficiary group and include number, gender, age, religious and ethnic background as well as the criteria by which they have been selected. b. Who will be included in the project's implementation and what are their qualifications and experience?
3. Monitoring and Evaluation Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
a. Who is responsible for monitoring this project? Please describe how monitoring will be done?
b. What is the project’s long term aim and what will change in your community following the project’s implementation?
c. What are the project’s short term aims and in what way will this benefit the beneficiary group following this project?
d. List the indicators which point to the project aims having been achieved. (Indicators must be measurable).
e. What are the project's follow-up plans?
D. BUDGET 1. Total amount requested from EWI (in EUR): 2. Bank details: a. bank b. bank address c. BIC/SWIFT code d. full name and address of organisation e. organisation’s account no. / IBAN
2. Are there already any other means secured for this project? If so please list them*.
E. ADDITIONAL INFORMATION Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
1. Please use this space to include any additional information which would allow us to better understand your planned activity:
2. List contact details for at least 3 institutions religious communities or donors who are well acquainted with the work of your group (state name, position and organisation, telephone and e-mail): a. ........................................................................................... b. .......................................................................................... c. ..........................................................................................
3. Underline how you learned of the EWI Call for Proposals: a. through NGO networks (please name) b. through magazines/journals (please name) c. through colleagues/friends d. through faculties e. other
NOTE: The Budget table below must be completed and sent with the Application Form. The Glossary may be used to clarify terms used. Place and date: ……………………… Signature of person responsible for the project: ………………………………………….
Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
EWI BUDGET TABLE Please describe all planned costs and their sources as EWI. If the project will be implemented in Croatia the budget should be in HRK. For all other countries the budget should be in EUR. (Please use the EWI budget table and for all budget items put short description in your project proposal). PROJECT TITLE
no.
description
unit
A.
PROJECT COSTS
1.
Salaries for full time project personnel
amount
cost per unit
Bookkeeper
2.
Honorariums
3.
Project implementation costs
4.
Communication costs
5.
Travel costs
6.
Banking costs
B.
OFFICE COSTS
C.
TOTAL OF ALL PROJECT COSTS:
Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
total
amount requested from EWI
other funding sources
B. PROJECT DESCRIPTION 1. Project summary – briefly describe (in no more than 150 words)
2. Underline one the fields within which your project falls: 1. peace-building and reconciliation 2. ecumenical and inter-religious cooperation 3. gender advancement
3. Describe the problem your project seeks to address. How was this problem identified and whom does it affect? 4. Briefly describe the social, economic and political context in which the project will be implemented.
Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
C. PROJECT IMPLEMENTATION 1. Activities a. Location: b. Timeframe: c. List the activities chronologically and person responsible for each of the planned activities. (Describe each activity in detail and where needed please extend the table).
Activity
Time of implementation
no.
Location
(date & duration of each activity)
Project personnel/ name of trainer
1. 2. 3.
Description of each activity: 1. 2. 3.
2. Beneficiary group a. Describe the beneficiary group and include number, gender, age, religious and ethnic background as well as the criteria by which they have been selected. b. Who will be included in the project's implementation and what are their qualifications and experience?
3. Monitoring and Evaluation Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
a. Who is responsible for monitoring this project? Please describe how monitoring will be done?
b. What is the project’s long term aim and what will change in your community following the project’s implementation?
c. What are the project’s short term aims and in what way will this benefit the beneficiary group following this project?
d. List the indicators which point to the project aims having been achieved. (Indicators must be measurable).
e. What are the project's follow-up plans?
D. BUDGET 1. Total amount requested from EWI (in EUR): 2. Bank details: a. bank b. bank address c. BIC/SWIFT code d. full name and address of organisation e. organisation’s account no. / IBAN
2. Are there already any other means secured for this project? If so please list them*.
E. ADDITIONAL INFORMATION Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
1. Please use this space to include any additional information which would allow us to better understand your planned activity:
2. List contact details for at least 3 institutions religious communities or donors who are well acquainted with the work of your group (state name, position and organisation, telephone and e-mail): a. ........................................................................................... b. .......................................................................................... c. ..........................................................................................
3. Underline how you learned of the EWI Call for Proposals: a. through NGO networks (please name) b. through magazines/journals (please name) c. through colleagues/friends d. through faculties e. other
NOTE: The Budget table below must be completed and sent with the Application Form. The Glossary may be used to clarify terms used. Place and date: ……………………… Signature of person responsible for the project: ………………………………………….
Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
EWI BUDGET TABLE Please describe all planned costs and their sources as EWI. If the project will be implemented in Croatia the budget should be in HRK. For all other countries the budget should be in EUR. (Please use the EWI budget table and for all budget items put short description in your project proposal). PROJECT TITLE
no.
description
unit
A.
PROJECT COSTS
1.
Salaries for full time project personnel
amount
cost per unit
Bookkeeper
2.
Honorariums
3.
Project implementation costs
4.
Communication costs
5.
Travel costs
6.
Banking costs
B.
OFFICE COSTS
C.
TOTAL OF ALL PROJECT COSTS:
Ekumenska inicijativa žena Poljički trg 2a, 21310 Omiš – Hrvatska Tel: +385 21 862 599 Fax: +385 21 757 086 e-mail: [email protected]
total
amount requested from EWI
other funding sources
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