SAAF Round 4
Concept note - Application Form
Please ensure that you have carefully read the ‘Concept note Application Guidelines’ before submitting
your application. Sections 1, 2 and 3 of this application form must have a maximum of 11 pages (excluding
this cover sheet, Annex one and the budget) and answer the questions as fully as possible providing all
the information that is requested. Please complete the budget template, as well as providing all the
complementary documentation requested.
If you have any questions, please contact the SAAF Secretariat at [email protected]
Checklist
Please make sure that all the necessary documents are attached:
☐Application form with all the sections completed maximum 11 pages (word document)
☐ Certificate of Registration of the organization (if the project is through a group of organisations or
network, please provide this information only for the leading organization).
☐ Tick this box if your organisation is not registered. You can apply if you do not have a
registration, but you will need a fiscal sponsor (see guidelines for more information)
☐ List of other projects, including their financial sources, currently being undertaken by the organization
(see Annex one)
☐ Your most recent audited financial statements (if the project is through a network/alliance, please
provide this information only for the leading organization).
☐ Tick this box if your organisation does not have audited financial statements
Details for submitting application forms
DELIVERY: Application forms and relevant documentation should be sent by email to
[email protected]
CLOSING DATE AND TIME: 21 May 2017 at Midnight BST/London time
We look forward to hearing from you
Section 1: Your Organisation
1.1 Organisation name and address
1.2 Organisation total budget (US$)
2016: US$
2015: US$
1.3 When was the organisation
founded?
1.4 How many staff does your
organisation currently employ?
1.5 Does the organisation have a
dedicated finance officer or
accountant?
Yes/No
1.6 Have you received an
international grant before?
Yes/No
1.7 Primary contact person for this
project:
Name:
Job title:
Telephone number (incl. country code):
Email:
Skype:
Additional contact person (optional)
Name:
Job title:
Telephone number (incl. country code):
Email:
Skype:
1.8 Anonymity: Yes ☐ No ☐
1.9 Are you applying with a fiscal sponsor? If yes, please provide the organisational name of the
fiscal sponsor. Please ensure that at least one of the contact people above is from the sponsoring
organisation. Remember that you only need a fiscal sponsor if you are an organisation without a
formal registration.
1.10 Mission, vision and key values of the organisation (200 words)
1.11 Describe any experience you have working on the issue of abortion (200 words).
1.12 Your organisation and SAAF
Have you applied for SAAF funding
in the past?
Yes/No
If yes, did you receive a grant?
Yes/No
How did you hear about this call for
concept notes?
Section 2: Project Summary
2.1 Project title:
2.2 Project summary (max. 150 words). This summary should reflect the specific nature of the
project, the challenge to be addressed and what it is intended to achieve:
2.3 Total budget
requested (US$):
2.4 Proposed start Start date:
and end dates
End date:
(day/month/year):
2.5 Which grant
stream(s) will the
project focus on?
Please note that
the project can
address more than
one grant stream
Grant stream 1: Supporting progressive abortion laws and policies through
targeted advocacy ☐
Grant stream 2: Breaking the silence and changing attitudes and norms
towards abortion through awareness raising and behaviour change ☐
Grant stream 3: Improving access to abortion services ☐
Grant stream 4: Generating understanding and evidence on abortion
through research ☐
Section 3: Purpose and outline of the project
3.1 Describe the problem that the project will address. Why is it important that you do this
project? What is its justification? (max. 700 words)
3.2 What is the overall goal of the project? (maximum 50 words)
3.3 What are the objectives of the project? (3 to 5 objectives – you can add more objectives if
needs be below)
Objective 1:
Objective 2:
Objective 3:
3.4 Who are the ultimate beneficiaries of the project? How will the project improve the lives of
the poorest, most vulnerable and hard to reach women and girls? (maximum 200 words)
3.5 How will your project address gender inequalities in your given context? How will you know
that your project has done this? (maximum 200 words)
3.6 Project activities: What will you do to achieve the above objectives and address the problem
outlined in section 3.1?
Objective 1:
Activity 1.1:
Why this activity?
Activity 1.2:
Why this activity?
Objective 2:
Activity 2.1
Why this activity?
Objective 3:
Activity 3.1:
Why this activity?
3.7 Project sustainability and systemic impact. Please describe your expectations for replication,
scaling up and lasting impact of the project’s results. Please also indicate whether you anticipate
the project having an impact on reproductive health services in general and the state of public
health in your country (maximum 300 words)
3.8 External technical assistance requirements: Please describe any technical support you might
require and how this will be provided. (maximum 300 words)
Organisation Executive Director (or person responsible):
Name:
Date:
Annex One
List of current projects implemented by the organisation:
Name of the
project
Thematic area
of work
Source of
funding/Donor
Total Funding
amount (US$)
Start and end
dates