Application for Grassroots Cultural Grant

Date :

Country : Name of Organization :

Officer in Charge : Tel. : Fax. : Mobile :

Name of the project : (in English)

Outline of the project

Applying organization : (in English)

Kind of organization : 1) Japanese NGO 2) NGO with international activities other than 1) 3) Local NGO 4) Rural public organization 5) Research center 6) School / University 7) Private cultural organization 8) State owned organization 9) Others (

Amount of grant (in hard currency)

-1- I. Concerning the project :

1. Aim of the project

2. Description of the project (in details)

3. Site of the project (attach a map)

-2- 4. Equipment List :

Detailed items

No Item's Price Suitability

Total :

-3- 5. Estimates by three suppliers

1) Concerning the three suppliers are (circle the appropriate answer)

1. Already got the estimates

2. Got two estimates out of three

3. It is difficult to get estimates

2) In case of choosing No. 3. above, what is the reason of difficulty ? (Are estimates made upon receiving the actual items, only ? are the officials not used to write estimates ? etc) and must the amount be determined by the law ? -4-

c) In case of availability of more than one estimate check according to the following

1) For particular items obtaining, if the case is that there are more than one supplier which one can supply them, and if there is one supplier who can supply all the items, without the involvement of the receiving organization in labour or supervising, that one is to be chosen

2) For the particular items, if the price is different by each supplier and one of them is cheaper in price and can supply the items as one set, this one is to be chosen.

3) In case of not choosing the cheapest supplier regarding the goods nature the work of the officials and the service.

6. Expected effect of the project -5-

7. Related matters

1) Relations with other donor(s) (including international organization and other NGO)

2) If the applying organization is a Japanese NGO

1. Is the country in which the grassroot cultural grant is implemented applying for NGO assistance

1. Yes 2. No

2. If Yes

Name ------

(N.B.) According to the regulations, the project which is receiving NGO Assistance can not receive Grassroot Cultural Grant.

II. Concerning the applying organization

1. Name : (in English)

------

2. Kind of the organization (According to the classification stated in page 1)

------

Answer the following according to the classification of the organization

3. If the organization is an NGO, a center for research or study (1) Establishment date (2) Staff (in case of a school include also the number of students, etc. In case of granting study equipment include the number of technicians, etc.) (3) Has the organization received a grant from Japan ? Yes ------No ------(4) Assistance from another donor country. Relation with other organizations (5) Relationship with the central government (is it registered in the NGO list), etc. (6) Annual budget. Detailed administration budget (7) Available equipment (8) Result of recent activities

4. If the organization is a rural public organization (1) If compared to the Japanese rural public organizations, to which level is it equal (prefecture, city town, village, etc.) (2) Population in its region (3) Annual budget. Detailed administration budget (4) Available equipment (5) Result of recent activities -7-

5. If the applying organization is not a rural public organization, including the case if it is a central government body

(1) The authority to which it is affiliated (Directly to the President, Foreign office of the Ministry of Finance, etc.)

(2) Specialization

(3) Is there actual results of the project implemented by the applying organization receiving assistance from Japan or another donor country ? Yes ------No ------

(4) Annual budget. Detailed administration budget

(5) Already available equipment

(6) Results of recent activities

6. Comment by the Embassy on the applying organization (Extent of confidence in this organization, its importance in the country, etc.)