A. GENERAL INFORMATION SHEET
1.1 Project title
not more than 10 words that reflect the essence of the project
1.2 Total Budget (in local
currency and in euros at
the rate of NBU )
1.3 the name of the
organization that runs
the project
1.4 form of entity's
incorporation
1.5 Code of the organization
1.6 legal address of
organization
1.7 physical address of
organization
1.8 telephone, fax, e-mail,
website
Name and address:
Director:
Contact person:
1.9 Project holder
Communication officer contact:
Email:
Telephone / Mobile:
Skype:
PROJECT TITLE / DATE
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Website address:
Start date:
1.10 Project start & end
dates:
1.11Reporting Schedule
End date:
The term of the project implementation shall end by June 30, 2017 + 2 months for
review and assessment of final reports (narrative, financial, financial audit and
evaluation)
Mid-term report: quarterly (narrative and financial reports, photo report) and
monthly short narrative report with project time schedule for the next month
Final report: in accordance with the conditions of the Agreement
1.12 Geographical focus
District(s)/province/city (Diocese/parish)
1.13 Affiliated entities (if
applicable)
1.14 Beneficiaries
Total number of direct beneficiaries (individuals) :
(see section 5)
Number of indirect beneficiaries (individuals):
(see section 5)
1.15 Goal and tasks of
project
1.16 Compulsory documents
to be attached
1.17 Recommended further
documentation to be
provided
1.18 Bank Details: Note that
for the grant and the
State the Goal of the project (the end-point of which is directed on your project )
and methods of its achievement (max. 0,5 page)
Annex 1) Budget
Annex 2) Activity Plan
Annex 3) Copy of Certificate of Legal Registration of the Organisation
Annex 4) Copy of Official Statute of the Organisation
Annex 5) Certificate of tax inspectorate on entering the Organization to the Register
of Non-Profit Organizations, specifying the unprofitability code
Annex 6) complete lists of previous projects and activities performed and
connected with the objectives and results of this call with sufficiently detailed
information which allows the Technical Committee to assess the operational
capacity
Annex 7) Curriculum vitae or description of the profile of the key project staff
primarily responsible for managing and implementing the project.
Annex 8) bank certificate on the opened bank account and balance on it
a) annual audit report
b) report on the work fulfilled within the year preceding the project proposed
for being financed
Detailed Assessment Report
c) a letter of recommendation from a local church
d) A letter of recommendation from previous donors, or project partners
Name of Bank:
Address of Bank:
PROJECT TITLE / DATE
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project applicant must
have a separate bank
account with "0" balance
of which it will be used
only for implementation
Tel. nr. of Bank:
Account Holder:
account number:
B. PROPOSAL
1. PROBLEM ANALYSIS (max. 2pages)
Describe the main problem (s ) on resolving which your project is aimed at. State the aspects in resolving
the problem which will be affected by your project.
Describe the background of the problem (s ) . Specify the sources that may evidence the existence of the
problem and its scales
The problem analysis should be based on a needs assessment:



Needs Assessment: when, by who and what was the methodology.
What are the key problems that the crisis-affected people face? (who, what, where)
What are the current response gaps?
2. PROPOSED RESPONSE (max. 3pages)
A. Geographical Focus


Name the geographical areas covered by the project as well as the administrative structures and
dioceses (provinces).
Justify the geographic targeting decisions.
B. Security Situation


Describe the security situation in general, and how it might affect the project implementation
Indicate the appropriate security status below:
Extreme: Serious security risks ; no or very limited access to the project site .
Tense: Varied security risks; may limit access to target areas at times
Normal: No significant security risks that may affect the response
Specify the measures for providing of the physical security of project implementers
and beneficiaries
C. Project activities / Expected results and performance of the project
PROJECT TITLE / DATE
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Specify the methods used to achieve the goal of the project. Briefly describe the form and content of
each project measure.
Describe specific, measurable , short-term results and long-term impact on the target audience of the
project.
Expected result
Indicators of
achievement
(indexes after
that you will be
able to measure
progress of
project)
Base level
Pre-arranged
indexes
Confirmative
documents
3. COMMUNICATION

Please describe any planned communication or media activities.
4. CONTINGENCY SCENARIOS(max. 1/2 page)



Identify the risks your project faces
Specify a plan to be used in case of unforeseen circumstances in order that a project could work in
the conditions of an increased danger
If the emergency situation spiralled out of control and needs might change, identify how the
project will retain flexibility and fast ensure response to changing needs
5. BENEFICIARIES(max. 1 page)
5. a) Direct Beneficiaries
Note: Direct beneficiaries are those who will directly receive assistance or protection.
If the same individual is a recipient of multi-sector assistance, this beneficiary should be counted only once.
The number of households receiving the assistance:
Average number of family members per household:
Total Number of Beneficiaries (individuals):
Optional: (if secondary data available)
Women:
Children:
Men:
Elderly:
Disabled:
Others (please specify):
Beneficiary Selection
Please determine the selection criteria used. How will the beneficiaries participate in the selection? In
what way can potential beneficiaries learn about the project ?
PROJECT TITLE / DATE
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5. b) Indirect Beneficiaries
Note : Indirect beneficiaries - those who indirectly receive assistance and are not related to the project.
Number of Households:
Total Number of Indirect Beneficiaries (individuals):
Optional: (if secondary data available)
Women:
Children:
Men:
Elderly:
Other (please specify ):
5. c) Beneficiaries by Sector
Here, list the number of individual direct beneficiaries by sector. The total number may exceed the total
number of beneficiaries if some people receive more than one type of assistance.
Food supply
Water, sanitation and hygiene
Housing (shelter , heating, reconstruction , etc.);
Health
Rehabilitation of the wounded
Other emergency cases related to children, the
elderly, the unemployed , etc
6. MONITORING, EVALUATION, ACCOUNTABILITY AND LEARNING(max. 1 page)
Monitoring



How will indicators be measured, by who and how often?
How will the received data be analyzed and used?
How are beneficiaries involved in the monitoring process?
Evaluation:

How will you evaluate and measure the impact of your project on the resolution of the problem?
Accountability:
 What mechanisms does the project have to be accountable towards beneficiaries?
 How does the project ensure meaningful and appropriate participation of different groups
especially with regards to marginalized/discriminated groups?
 How does the project share information with the community about coordination, available
PROJECT TITLE / DATE
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services, time-frame and exit strategy? How does the project ensure this information reaches
diverse groups?
Learning:
 What experience from your previous projects have you incorporated and applied in this proposal?
7. SUSTAINABILITY AND EXIT STRATEGY(max. 1/2 page)

Identify which project components will be sustained after the end of the project, and with what
financial and human resources. Demonstrate how these financial and human resources will be
ensured in this project’s life time, e.g. by setting up community financing, or by integrating
services into government projects, or by establishing partnerships with new funding
organizations.

Describe the exit strategy, setting out how the sustainable components will be phased, and how
other components will be closed. It is important for beneficiaries to be informed well in advance,
and informed where similar services can be accessed.
8. COORDINATION(max. 1/2 page)
Coordination and collaboration with other humanitarian agencies, organizations, the UN, and
governmental bodies is essential to deliver a quality humanitarian response.



Explain how your project relates to the overall humanitarian response in-country. What other
major international organisations and humanitarian agencies are operational in this emergency
and where are the gaps (e.g. in geographical coverage, sector or technical expertise, vulnerable
groups)?
In which clusters or alternative coordination mechanisms are you participating?
Are you participating in any other coordination mechanism?
9. PROJECT MANAGEMENT AND CAPACITY (max. 1 pages)
This section should discuss the organization’s past experience and capacity, the proposed role of affiliated
entities in the project, and the management and staffing structure for the project.
Management Capacity
 What experience does your organization have of managing projects of a major scale? Consider
the existing financial management, logistics/ procurement and technical capacity and identify
areas where increased capacity is needed.
Human Resources
The focus here is on staffing and skills, while above it is systems, structures and experience.
 Briefly set out the current organizational structure.
 Please set out the organizational structure required for this project. Indicate new positions
required, whether full-time or part-time.
Logistics
 What resources and equipment (e.g. , warehouses, means of transport , office equipment ,
premises ...) does your organization currently have that can be used under this project?
PROJECT TITLE / DATE
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10. BUDGET: FINANCIAL OVERVIEW AND BUDGET NARRATIVE
Complete the budget sheet according to the relevant template. Please follow the budget guidance notes.
Use the comments column on the budget summary page to show how budget lines are calculated.
Підписи засвідчують:
 зобов`язання організації подавати у проектній пропозиції правдиву
інформацію;
 всі фізичні особи, які названі у цій проектній пропозиції, надали письмову згоду
організації щодо надання та обробки їхніх персональних даних в рамках
діяльності за проектом відповідно до Закону України "Про захист персональних
даних".
Підпис керівника проекту
Дата “
”
201
р.
Підпис керівника організації
Дата “
”
201
р.
Підпис бухгалтера організації
Дата “
”
201
р.
МІСЦЕ ПЕЧАТКИ
ОРГАНІЗАЦІЇ
PROJECT TITLE / DATE
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