UNDP GEF/CCF Small Grants Programme

UNDP GEF SGP

Form: 2

APPLICATION FORM

(Please fill all the columns in the application form)

A. Organizational Profile

1. Name of the Organization: 2. Address and contact details:

Contact person: Phone: (O) (R) Fax: E-mail: Website: 3. Registration details: No. of years; (Please enclose relevant photocopies)

4. Organization details: a) Organizational Structure: b) Current Annual Budget: c) Total expenditure on the last three projects: i.e. Program based and Administrative based. d) Details of Current staff and Qualifications: indicate total number and number of professional, administrative and support staff etc. In each category, indicate the number of men and women. e) Proven in-house experience – evidence (in the science and technological component of the project) that the applicant can successfully implement the project. f) Demonstrated ability of the institution to mobilize resources from communities. g) Membership/affiliations to National/ State agencies or institutions. h) Office infrastructure of the NGO/CBO in the proposed project district/area. i) Current objectives and major activities undertaken by the NGO. (No More than 300 words). 5. Information regarding completed and ongoing programmes/ projects: a) Relevant project (related to GEF focal areas) implemented in the last 5 years

Sr. Name of Funding Agency Project Project Outcomes No. Project amount duration/present status

b) Who have been the partners in projects executed in the last three years: Government/National NGOs/Institutions; International Donors etc.. Please do not repeat the projects already listed in 5. a) Sr. Name of Funding Agency Project Project Remarks/ No. Project & contact person amount duration/present Achievements status (Outcomes)

Format revised as on 20th January 2008 UNDP GEF SGP

B. Details of the Project

A. General

6. Project Title: 7. Project Budget: 8. Project Location: (i) Region/State: Nearest City: (ii) No of Villages: Core: Dissemination:

9. Duration: 10. Person responsible for the Project:

B. Project Description

11 (a) Goal of the project (b) Purpose/Objectives of the project:

12 (a) Project Outputs (clearly defining measurable outputs) (b) Major Activities (required to achieve the Project Outputs, the activities can be defined for each of the Outputs.) (c) Time Schedule of activities to be clearly explained through Activity Charts (d) Key project Risks in doing the project

13. Justifications for the project (Why do you want to do this project). Please state benefits of doing this project. Clarify what benefits and innovation the project will ensure.

14. Project Strategy to achieve the project purpose and the outputs and linkages with other ongoing projects/ programmes of your organisation: (detail the use of village level micro planning)

15. Project Beneficiaries: (who benefits) 16. Role of Communities in the project (how it will ensure in taking decisions, fund contributions (cash/kind), ownership, planning, execution and implementation – not to exceed 150 words.)

17. Global Environment Impact of the project (Explain how this project helps through local actions to global benefits of environment in 150 words.)

18. Replicability of the project. How is it possible within the project period and after the project. 19. Sustainability of the project activities (Mechanisms and How)

20. Scientific and Technical Content (not more than 250 words) Scientific and Technical inputs required for the project and mechanisms for the same.

21. Relationship to SGP Thematic Area/Mandate, define the area..

22. How does the project demonstrate: Innovation, Participation and Gender Sensitivity and Equity in the proposed project.

C. Project Impacts

23. Project Impact Indicators (to monitor and evaluate progress in activities):

S. No Output Indicator(s)

24. Networks/ Links with Government / Line departments / scientific institutions/ academic Institutions and other agencies, etc. (Please specify how will these links be established and help in achieving the project objectives/goals)

25. What impacts it will create in terms of Policy/ Advocacy/ Sustainability/ and Replicability in long term.

26. Media Coverage (Needs to be encouraged and covered during the life of the project)

27. Project to make contacts. Other development/ environment agencies / projects using the same approach??

28. Does the proposal require any specific permission? Which are these? Have they been obtained from necessary Central/State/District level governments / Departments / Forest/Institutions? (If yes, please attach relevant documents).

29. Status of land on which the work is being proposed: Private lands; community land; Forest Deptt; Panchyat and Revenue lands etc. 30. Racial Discrimination: (please ensure and state that benefits of the projects will be available to all without any racial/religious discrimination).

D. Budget for the project:

31. Estimated total project cost:

32. Suggested format for Budget Break down (Please add heads/subheads/columns as required)

Sr. Components Amount Co- NGO’s and Total % of No requested finance* Communiti (Rs.) the from SGP (Rs) es total (Rs.) contributio budget ns (for (Rs) SGP only) Years 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 A. Project Activities (Please specify and give detailed activity wise break up with unit costs) B. Capacity building of staff & communities (Training, workshops,

exposure visits & seminars) C. Consultants/ Resource persons D. Monitoring & Evaluation E. Documentation & Reporting F. Formation of local institutions/groups G. Planning activities H. Travel Costs I. Any other (please specify) J. Salary K. Communications and Administration L. Contingency (not more than 2- 3 % of the total project cost)

*: Please specify whether in cash or kind (If in kind please convert into cash)

Notes :

1. All proposed costs should be reasonable and according to the local needs and should be justified and supported by the project partner. 2. Wherever possible, costs should be shared with communities, organization and or other donors to have better ownerships. 3. For contingencies costs, approval needs to be taken from the National Coordinator. Also certify that the SGP component is not being funded through any other source of funding agency.

E: Time schedule of Activities

As explained in point 12 (c)

Sl. Activities Month(s) / Year(s) No Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec

Signature of the authorized person With designation and stamp Annexures: 1. Annual Report 2. List of key professionals 3. Registration certificates 4. Audited financial reports of 3 years 5. Any other attachments (if required)

Format revised as on 20th January 2008