Section a - Cover

U.S. Embassy - Argentina Application for Funding – Program of Funds for Projects of Cooperation and Exchange

SECTION A - COVER 1. Grant program: “Rapid response” program (up to 75,000 pesos) Standard program (up to 350,000 pesos)

2. Applicant category: Organization Individual

3. Name of applicant: Indicate legal name of the organization or individual

4. Acronym of the organization (if applicable):

5. ¿Have you received funds from the Embassy before? Yes No If yes, please indicate when:

6. Project title:

7. Amount requested: (Argentine Pesos)

8. Applicant’s contribution, if applicable (Argentine pesos): A contribution can be both cash and in-kind including, but not limited to, materials, personnel, and meeting venues. Please include the monetary value of all contributions.

9. Contributions from other sources, if applicable (Argentine Pesos). Note name of organization and amount:

10. If your project is selected for a grant, do you agree to acknowledge funding from the U.S. government, and incorporate the Embassy logo in your communications and promotional materials? Yes No 11. Does the requesting organization or individual participate in social media (Facebook, Twitter, etc.)? Yes No If yes, please specify and give name of accounts:

12. Website of the requesting organization/individual: SECTION B – PROJECT NARRATIVE Please tell us about your project, including why you would like the Embassy to support this. Please answer all the questions below, using additional space when necessary. Context 1. Summary of the project (no more than 50 words):

2. Describe the group of people that will participate in the project (direct beneficiaries); including the number of people and their characteristics:

3. Have you worked with them before? If so, please indicate how:

4. Indirect beneficiaries (number of people who will indirectly be involved in the project):

Project 5. Describe each of the activities that will be carried out during the project:

6. Describe your work plan and project schedule, with estimated dates for each activity:

7. Explain the connection between your project and the United States (materials about or from the U.S., participation of U.S. experts, thematic relationship, etc.):

8. Please describe your method of assessment and be specific about projected outcomes as they relate to the goals of your program. (Include number of participants, regions represented in the participant pool, age range of participants, projected outcomes, etc.

2 9. Describe whether the projected outcomes will be measured through qualitative and/or quantitative means; if so, what specific method(s) will be applied to assess attainment of outcomes.

SECTION C – DESCRIPTION OF THE REQUESTING ORGANIZATION OR INDIVIDUAL APPLICANT Requesting individuals must answer questions 1 - 4, and organizations should answer all questions. 1. Address of the requesting organization or individual: Street: P.O. Box (if applicable): City: Province: Zip code:

2. Telephone number(s) of the requesting organization or individual:

3. E-mail of the requesting organization or individual:

4. CUIL/CUIT and Corporate Name (Razón Social)

5. Do you have a DUNS number (https://fedgov.dnb.com/webform )? If so, please provide it:

6. Does the organization have a legal status in Argentina (personería jurídica) Yes No

7. Contact person(s): Include the information of the person(s) in charge of communicating with the Embassy. Please also include the information of the person in charge of the organization’s financial management. a. Mr. Mrs. Ms. Last and first names: Position: b. Mr. Mrs. Ms. Last and first names: Position:

8. Year in which the organization was established:

9. Organization background: Brief description of the requesting organization’s mission, structure, and achievements. a. Mission (No more than 50 words):

b. Organizational structure (Refers to leadership and the form of the organization, which can include an Executive Board, Board of Trustees, Review Committee and/or CEO, etc.):

3 c. Operational structure (Refers to allocation of tasks within the organization that can include teaching, communications, administrative staff, etc.):

SECTION D - BUDGET

Provide an itemized budget in Argentine Pesos using the following format: . “Other contributions” refers to the resources that the organization will receive from other sources to execute the project; . In-kind contributions (for example, property, personnel, venue for meetings; etc. ) should include approximate market value in pesos; . Use the footnotes to indicate the source of each contribution.

Budget items (all that apply) Number of Cost per Total cost Amount Applicant’s Other units unit requested contribution contributions (if from the (if applicable) applicable) Embassy In AR Pesos In AR Pesos In AR Pesos In AR Pesos In AR Pesos E.g.: Transportation a. 3 tickets a. 12.000 a. 36.000 a. 24.000 a. 12.000 a. 0 a. Air ticket - Round trip: Houston- b. 2 trips b. 400 b. 800 b. 800 b. 0 b. 0 Buenos Aires c. 3 rooms c. 4.200 c. 12.600 c. 0 c. 0 c. 12.600 from b. Taxi (to and from) airport - hotel XX Foundation c. Hotel 3 nights in B.A. 1. Materials a. etc. 2. Rental Equipment a. etc. 3. Communications a. etc. 4. Transportation a. etc. 5. Honorarium a. etc. 6. Other costs a. etc. TOTALS Total cost: Total amount Total amount Total amount of requested of Other from the Applicant’s Contributions: Embassy: Contribution:

Examples of budget ítems:

Budget item Examples of subitems 1 Materials Learning materials, books, supplies, publications; etc. 2 Rental Equipment Rental of computer or office equipment, machinery; etc. directly related to the project. 3 Promotion materials Audiovisual materials, publications, social media, flyers; etc.

4 Transportation Taxi, bus/air tickets, per diem, accommodation. 5 Honorarium Professional or consultant fees directly related to the project.

4 Additional questions: If you do not receive the total amount of funds requested to the Embassy but only partial funding, would you be able to carry out the project? Yes No If yes, please indicate how.

If your project is selected, does the organization/do you have the necessary funds to make advance payments related to the implementation of the project before receiving the grant?

Yes No

Please send your application via email to: US-Ar [email protected] Indicate the title of your project in the subject line

Webpage: https://ar.usembassy.gov/