Response Fund

DAI - AWAAZ

RESPONSE FUND

I - Application Form

Proposal Number:(generated by RF/MO) AWWAZ OUTPUTS (Please tick only one output, which the project is primarily responding) 1) Community based initiatives for pre-emption of conflict and/or violence against women;

2) Fostering inclusion of differently abled (or disabled) persons;

3) Demonstration of innovative approaches in service delivery for health and education; Name of Applicant Organization:

Legal Status of the Organization:

Section 42 of Companies Ordinance, 1984

Trust Act, 1882

Voluntary Social Welfare Agencies Ordinance, 1961

Societies Registration Act, 1860

Partnership Act, 1932

The co-operative societies act 1925

Non-profit public benefits organization (governance & support) act 1925

Other (please specify):

Organization Registration Number: Mailing Address:

Name &Title of Head of the Organization: Cell number: Email:

Name &Title of Contact Person for Proposal:

Cell number: Email: Brief description of the proposed project: Describe specific, measurable, achievable, realistic and time-bound (SMART) objectives

Direct Beneficiaries of the Project:(Name the specific beneficiary group, e.g. minorities, women, other excluded groups.-details to be included in Technical Proposal)

Total Number of Direct Beneficiaries: ______

Total number of direct male beneficiaries:______Total number of direct female beneficiaries: ______

Indirect Beneficiaries of the Project

Total number of Indirect Beneficiaries: ______

Total number of indirect male beneficiaries:_____ Total number of indirect female beneficiaries: ______

Geographical area of proposed Project:

List Major Activities associated with each Milestone: Milestones: Major Activities: Milestones 1 Activity 1a Activity 1b Activity 1c … n Milestones 2 Activity 2a Activity 2b Activity 2c … n Milestones 3 … n Activity 3a Activity 3b Activity 3c …n Project Duration (in Months): Please note that no extension will be allowed for project.

Planned Date of Project Commencement: Planned Date of Project Completion:

Budget Overview in PKR:´

Total Budget (PKR):

RF Contribution (PKR)

Applicant Contribution(PKR): (if any)

I hereby declare that the information provided is true and correct.

I hereby declare that I have not applied, obtained, or will be obtaining any other financial incentives for

this project.

Signature Date

Name of Applicant (Please print) Stamp of Organization

Application submission guideline:

 RF application package comprises of RF application form, Technical Proposal and Financial Proposal. It should be submitted by (Date): ;

 One organization can only submit one application;

 One hard and soft copy of the proposal package should be provided. Soft copy to be provided in thumb drive/USB;

 The RF Application Package should be submitted at the following address:

Strategic Learning Unit/Response Fund

House - 4A, Street no. 42, Sector F-7/1, Islamabad, Pakistan