CERF Application Template July2015 EN Project

CERF No.

Version

Country

To be completed by CERF secretariat Date

Sector

Agencies should submit individual project proposals per sector/cluster. For example, one agency would submit two separate individual proposals for WASH and for health. Joint sector/cluster proposals are acceptable only when agencies are jointly implementing the activities for the same targeted people in the same location. Otherwise, please submit separate agency proposals.

III. AGENCY PROJECT PROPOSAL

1. Requesting agency or agencies

2. Project title

3. Cluster/sector

4. Geographic areas of implementation targeted with CERF funding (by first and second level administrative divisions – please be specific)1

5. Implementation start date of CERF-funded activities (rapid response projects only) For rapid response projects the implementation deadline is six months from the date of disbursement or, where specified, from the start date provided below (which must not be earlier than six weeks prior to the disbursement date). a. Will implementation of the CERF-funded activities start prior to disbursement of funds? Yes No

b. If “Yes” please provide start date (day/month/year):

6a. Total requirement for agency’s sector response to current emergency US$ For rapid response requests, this refers to the funding requirements of the requesting agency in the prioritized sector for this specific emergency and the new emergency response phase only. For underfunded emergency requests, this refers to the agency’s funding requirements for the corresponding activities in the HRP. If HRP project exists, use the project requirement. Where no HRP exists, ‘total project requirement’ should reflect the funding requirements of the requesting agency for its humanitarian programme in the prioritized sector for the targeted geographical location. Fundi ng For joint projects, please break down by agency this and the following amounts (6b and 7). (USD) 6b. Total funding received so far for agency’s sector response to current emergency US$ Indicate the amount received against the total indicated in 6a above.

7. Total amount of CERF funding requested for this project proposal US$ The total requested from CERF should not be 100% of the total request, as CERF funding should be complemented by other funding sources. Normally, CERF contributes to a limited amount of the total project requirement to jump-start an emergency response.

1 Please be specific with the target areas of this project. First administrative level can be provinces, states, governorates or regions. Second administrative level can be districts, prefectures, municipalities, cantons or townships.

| CERF Application for Grant Funding | [email protected] | cerf.un.org 8a. Total number of individuals (girls, boys, Female Male Total women and men) directly targeted with CERF < 18 years funding2 ≥ 18 years Total

8b. Beneficiary profile Category Number of people In addition to the breakdown by girls, boys, women and Refugees men above, please provide a beneficiary profile by 3 category. Totals must match. Please do not change the IDPs categories and do not add additional lines. Host population “Other affected people” includes people affected by Other affected people natural disaster or conflict who have not been displaced and are not hosting refugees or IDPs, or people Total (same as in 8a) affected in any other way.

9. Humanitarian Response Plan project code, HRP Project Code HRP Priority Ranking CERF funding for project ranking, and objectives US$ For countries with an HRP: If applicable, please list the US$ HRP cluster objectives and strategic objectives to which this CERF project will contribute. HRP Cluster Objectives (if applicable, please specify the cluster): Where more than one HRP project code applies to a  single CERF project proposal, please also specify the amount of CERF funding requested against each HRP  project code (add lines as required). For joint projects, please indicate the agency for each HRP Strategic Objectives (if applicable): HRP project.  

10. Priority humanitarian needs in the sector: What are the time-critical needs in the sector? For rapid response, what are the new or increased humanitarian needs? Why is this sector prioritized in the CERF application?

GUIDANCE (delete when completed) - For rapid response, highlight the new or increased needs directly resulting from the current crisis. - What are the different needs of girls, women, boys and men of different ages? - Reference the dates and types of needs assessments used to develop the project, including the Multi-Cluster/Sector Initial Rapid Assessment (MIRA), sector-specific technical assessments and others as applicable.

[Insert text here]

11. Overall sectoral response: How is the sector/cluster responding to the needs? What is the target population? What are the overall outputs? If applicable: What is the target population and which geographical areas are targeted in the Humanitarian Response Plan or other humanitarian planning document?

GUIDANCE (delete when completed)

2 Please count only the individuals benefitting directly from this CERF grant. The population benefitting indirectly from this CERF funding should not be included, although the country team may choose to describe the additional beneficiaries of the project in section 10 of the proposal.

3 IDPs are defined as “persons […] who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized state border” (UN Guiding Principles on Internal Displacement).

| CERF Application for Grant Funding | [email protected] | cerf.un.org - For underfunded emergencies, describe the overall agency project as included in a Humanitarian Response Plan or other humanitarian planning document in country. Include the objectives, types of activities with population types and number of people targeted and geographic locations of the overall project. - For rapid response, describe the agency or sector/cluster’s overall response to the new or increased needs. What additional activities are planned to respond to the new needs? What increase in humanitarian programme is proposed? - Explain how the project contributes to the sector/cluster priorities. - Explain briefly how affected people were involved in the design of the response and how they will be consulted throughout the implementation of the project.4 Provide information on the individuals targeted by the overall project/programme, and explain how identified gender issues will be addressed in project/programme design and implementation, to ensure that the needs of women, girls, boys and men are met equally. - Explain how potential implementing partners were involved in the design of the response.

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12. CERF project (1 page text plus results framework): What will your agency accomplish with CERF funds? Who is the target population? What are the specific outputs?

12a. Summary of CERF project

GUIDANCE (delete when completed) - Of the overall response (question 11), what portion will be supported with CERF funds? - Describe the individuals to be targeted by the CERF project, targeted number of people and their geographic locations. Highlight any particular groups of concern. - Explain how the CERF project adheres to the CERF life-saving criteria.5

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12b. CERF project results framework

GUIDANCE (delete when completed) - The project results framework should provide a brief overview of key deliverables and results expected for the CERF component of the project. It is not meant to serve as or replace agencies’ own fully developed project log-frames. - Please use the table below and add lines as necessary to capture the key deliverables of the CERF project. - The framework below is also an opportunity for elaborating and illustrating aspects of the project related to gender and accountability to affected people (as outlined under Point 10 above). - Please break down target population figures in the results framework by sex, age and other relevant characteristics. - If activities are implemented by project partners please indicate the name of the implementing partner. - The results framework should represent the CERF portion of the project only. If activities and outputs cannot be directly linked to CERF funding please estimate or prorate as best possible. - Please use standard indicators from the HRP or Indicators Registry whenever possible.6 - The example below should be deleted before submitting the proposal to CERF. For additional guidance and a larger example of a results framework, see Annex B.

4 As per the IASC five Commitments on Accountability to Affected People/Populations (CAAPs, details athttp://www.humanitarianinfo.org/iasc/).

5 The CERF Life-Saving Criteria, which specify activities by sector that CERF can fund, are available at http://cerf.un.org

6 The Indicators Registry is available at https://ir.humanitarianresponse.info/

| CERF Application for Grant Funding | [email protected] | cerf.un.org EXAMPLE (complete the empty table below and delete this example)

CERF Project Results Framework Project objective Outcome

| CERF Application for Grant Funding | [email protected] | cerf.un.org statement

Output 1 Output 1 Description Baseline Target Indicators Indicator 1.17 Indicator 1.2 Indicator 1.3 Output 1 Description Implemented by8 Activities Activity 1.1 Activity 1.2 Activity 1.3

Output 2 Output 2 Description Baseline Target Indicators Indicator 2.1 Indicator 2.2 Indicator 2.3 Output 2 Description Implemented by Activities Activity 2.1 Activity 2.2 Activity 2.3

Output 3 Output 3 Description Baseline Target Indicators Indicator 3.1 Indicator 3.2 Indicator 3.3 Output 3 Description Implemented by Activities Activity 3.1 Activity 3.2 Activity 3.3

12c. Gender marker and gender-based violence

GUIDANCE (delete when completed)

7 Please use standard indicators from the HRP or Indicators Registry whenever possible. The registry is available at https://ir.humanitarianresponse.info

8 For joint projects, please indicate for each activity, which agency is responsible, even if the activity is to be implemented by a partner.

| CERF Application for Grant Funding | [email protected] | cerf.un.org - In the table below, provide the IASC gender marker scoring (0, 1, 2a, 2b, NA).9 Provide a gender marker score for each project, whether it is in an HRP or not. Explain the score. - In the table further below, indicate whether the project has a component on gender-based violence, and explain.

Gender Marker Description and Justification

NA – Not applicable

0 – Gender Not Reflected

1 – Limited Gender Consideration

2a – Gender Mainstreaming

2b – Targeted Gender Action

Gender-based violence Description and Justification

Does this project consider gender-based violence (GBV) in its design? Yes, its main objective focuses on GBV

Yes, it has a GBV component

13. Implementation Plan: When will the activities be carried out? By whom? How will the project be coordinated with other projects or sector/clusters? How will the activities be monitored?

13a. Implementation timeframe

GUIDANCE (delete when completed) - Specify the duration of the CERF project and provide an activity timeline, as per below suggested format.10 CERF allows up to six months for rapid response grants, and about nine months for underfunded grants. - Briefly describe how the activities funded by CERF will be sustained beyond this CERF project. - Please complete the workplan below by highlighting the cells (each cell represents one week). Outputs and activities must be the same as in the Results Framework above. Insert the actual calendar months instead of “Month 1”, etc.

CERF Project Implementation Plan Project duration Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Rapid Response Implementation Period Underfunded Implementation Period

9 A gender code is assigned based on three critical components: 1) there is gender analysis in the needs assessment that provides relevant sex and age-disaggregated data and gives insights into local gender issues; 2) this needs assessment is used to identify activities; and, 3) gender-related outcomes. For more guidance, see https://www.humanitarianresponse.info/themes/gender/the-iasc- gender-marker

10 Requesting agencies can also choose to use their own format but it must demonstrate the time schedule for the CERF project period to complete the outputs and activities as outlined.

| CERF Application for Grant Funding | [email protected] | cerf.un.org Output 1 Activity 1.1 Activity 1.2 Activity 1.3 Output 2 Activity 2.1 Activity 2.2 Activity 2.3 Output 3 Activity 3.1 Activity 3.2 Activity 3.3

13b. What are the implementation arrangements? Who are the implementing partners? What is the coordination structure?

GUIDANCE (delete when completed) - Who are the implementing partners? Please provide names. - Describe roles and responsibilities of your agency and implementing partners to deliver the CERF-funded assistance. Who is responsible for what activities? In what locations? - When will funds or in-kind support be transferred to implementing partners? When will the partners begin activities? - How will this project be coordinated with other projects in the same area or targeting the same affected people?

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13c. How will implementation be monitored, evaluated and reported on?

GUIDANCE (delete when completed) - Describe the monitoring and evaluation arrangements for the CERF project. On monitoring, please describe plans for tracking project progress, including site visits, data collection, reporting and other arrangements, as relevant. - Describe any evaluations planned for the CERF project or overall programme of which CERF is part. Explain how and who will carry out the evaluation. - Describe any other accountability mechanisms set in place for this project.

[Insert text here] 14a. CERF Project Budget Please use the template below without modifying the section headings. Wherever possible and relevant please provide a detailed breakdown of items (unit, quantity, unit costs) and costs for each budget line for the CERF component of the project. Where breakdown of unit, quantity and unit cost is not available or irrelevant, please provide total amount of the item along with sufficient description of cost content. Please add additional rows, as needed. For joint project, each agency has to develop a separate budget (tables 14a and 14b). Please refer to the CERF application budget guidelines in Annex A of this document or available at http://cerf.un.org

Cost Breakdown Budget Lines Unit Quantity Unit Cost Total (USD) A. Staff and Other Personnel Costs (please itemize costs of staff, consultants and other personnel to be recruited directly by the agency for project implementation

Sub-Total A:

| CERF Application for Grant Funding | [email protected] | cerf.un.org Cost Breakdown Budget Lines Unit Quantity Unit Cost Total (USD)

B. Supplies, Commodities, Materials (please itemize direct and indirect costs of consumables to be purchased under the project, including associated transportation, freight, storage and distribution costs)

Sub-Total B:

C. Equipment (please itemize costs of non-consumables to be purchased under the project)

Sub-Total C:

D. Contractual Services (please list works and services to be contracted under the project)

Sub-Total D:

E. Travel (please itemize travel costs of staff, consultants and other personnel for project implementation)

Sub-Total E:

F. Transfers and Grants to Counterparts (please list transfers and sub-grants to project implementing partners

Sub-Total F: G. General Operating and Other Direct Costs (please include general operating expenses and other direct costs for project implementation)

Sub-Total G: Total Project Direct Costs Total project direct costs

Indirect Project Support Costs (PSC) (must not exceed 7% of total project costs) PSC rate PSC amount Total CERF Project Budget

| CERF Application for Grant Funding | [email protected] | cerf.un.org 14b. Breakdown of CERF Budget by Implementing Partner Type Please provide the total amount planned for partner implementation and include an estimate of the planned breakdown of funds by implementing partner type. The sum of b. and c. should match budget Category F; the Total should match the Total CERF Project Budget.

Amount (USD) a. Direct implementation by UN/IOM (incl. PSC) b. Total NGO and Red Cross/Red Crescent partners c. Total Government partners Total

| CERF Application for Grant Funding | [email protected] | cerf.un.org Annex A: Budget Guidance

Each CERF project proposal must include a budget which details the costs to be funded by CERF and which strictly adheres to the CERF budget template and CERF budget guidelines (see below). The CERF budget template is in line with the UNDG budget categories. The budget should reflect activities described in the project narrative, and include sufficient detail to provide a transparent overview of how CERF funds will be spent. Budgets should be designed taking into consideration the CERF- approved implementation period of the project (maximum six months for rapid response grants and around nine months for underfunded grants). If more than one agency will implement a project, a joint narrative can be presented but separate budgets must be completed for each agency. There will be a separate disbursement to each agency, as CERF funds cannot be passed from one agency to another.

Budget Line Guidance on Cost Breakdown A. Staff and Other Personnel Costs Unit Quantity Unit Cost Total

 Staff costs should usually not exceed 10% of the Total Project  Provide unit, quantity and unit cost by monthly or daily Direct Costs rates for each position  Costs and entitlements of national and international staff  Specify whether the rate is monthly or daily directly involved in the implementation of the project  If a position is cost-shared, budget the portion of  Itemize each national and international staff by function and monthly cost that the person will dedicate to the grade/level CERF project.  National and international consultants contracted directly by the agency. Describe the function and expertise of the consultants hired for the project  Other project personnel such as temporary staff and daily workers directly contracted by the agency  Do not include consultancies with firms (which go under budget category D) or agreements with implementing partners (budget category F)  CERF does not fund Government staff salaries  Keep staff and other personnel costs to the essentials for emergency response B. Supplies, Commodities, Materials Unit Quantity Unit Cost Total

 Procurement of consumable supplies for project  Provide unit, quantity and unit cost for each type of implementation (e.g., drugs, food, non-food items, tents, seeds, consumables to be purchased tools, etc.)  If a consumable is in the form of a kit, provide an  Costs associated with the delivery, storage and distribution of itemized list of the content of the kit in an annex or consumable supplies procured by the project, such as refer to the standard kit descriptions agreed with transportation, freight, customs, insurance, warehousing and CERF other logistical requirements  Provide details on medicines or the contents of kits in an annex  Communications materials for training and awareness raising, such as posters, pamphlets, etc., as well as the reproduction of these items  CERF does not fund agency-specific visibility materials C. Equipment Unit Quantity Unit Cost Total

 Procurement of non-consumable items for the benefit of project Provide unit, quantity and unit cost for each type of recipients (e.g., IT equipment for registration, medical equipment to be purchased equipment, etc.). Low value items should be budgeted in budget category B.  CERF generally does not fund the purchase of vehicles  Only equipment directly related to project implementation will be considered. Equipment for agency regular operations will not be accepted D. Contractual Services

| CERF Application for Grant Funding | [email protected] | cerf.un.org Budget Line Guidance on Cost Breakdown  List and describe the works and services – normally of a  Provide unit, quantity and unit cost for each contract commercial nature – contracted directly by the agency following procurement procedures  Provide the names of contractors if possible Budgets for implementing partners (NGOs or Government partners) should be included in budget category F. E. Travel Unit Quantity Unit Cost TOTAL  Travel costs of staff, consultants and other project personnel,  For staff, consultant and other personnel travel, such as daily subsistence allowance, international and local provide details on the number of days, DSA rates and flights, hazard pay and other travel entitlements, as applicable national and international flight costs (round or single  Itemize by international and internal/national travel and indicate trip) for whom the travel cost is  Provide unit, quantity and unit cost for vehicle or boat  For all travel, provide the number of travellers, number of days, rental, including fuel for internal travel destination and DSA rate  Include fuel and vehicle or boat rental costs for staff, consultants and other project personnel  The inclusion of international travel is discouraged. If included, a strong justification is required F. Transfers and Grants to Counterparts Unit Quantity Unit Cost TOTAL  For partners– normally of a non-commercial nature –  Lump sum cost per partner contracted by the agency through sub-granting procedures for project implementation. Entities receiving sub-grants could be NGOs, Government or other non-commercial entities  For each implementing partner, provide the name of the partner (NGO or government), amount of funds to be transferred. Please provide a description of the partner’s outputs and a general breakdown of the budget. For example:  Distribution of 800 MT of food commodities to ABCD beneficiaries in XX, YY and ZZ locations. 800 MT x $150/MT = $120,000  Deployment of two mobile health clinics to XX and YY locations for a five-month period. $25,000/month x 5 months = $125,000.  Costs allowed to be incurred by partner include: 1. Staffing: cost of personnel recruited by the implementing partner to carry out the services sub-contracted by the agency 2. Direct operational cost: all costs of direct operational inputs (equipment, supplies, transport, etc.) for delivery of services 3. Other direct costs: general operating and office running costs for the partner to carry out the services/works for this project G. General Operating and Other Direct Costs Unit Quantity Unit Cost TOTAL  General operating costs, including office running costs, office  Itemize the other direct costs by unit, quantity and unit stationary and supplies, and utilities such as cost telecommunications, internet, and office rents for project  Lump sum costs can be accepted provided implementation. For office rents, provide office locations satisfactory description on what the lump sum covers  Other costs that cannot be mapped to the expense categories and how it is estimated above, such as agency-specific standard provisions such as technical supervisory support, monitoring and evaluation, reporting, and others as agreed with CERF  CERF does not fund recurrent costs for regular agency operations including regular agency security costs.

| CERF Application for Grant Funding | [email protected] | cerf.un.org Budget Line Guidance on Cost Breakdown Total project direct costs This is the sum of budget lines A to G. Indirect project support costs  To cover PSC at HQ/regional and country level.  Must not exceed 7% of total project direct costs Sum up total project direct costs and indirect project TOTAL PROJECT BUDGET support costs a) Please use a comma “,” rather than space or “.” as thousands separator, e.g. “$1,234” b) Subtotal, PSC and total amount is rounded to the nearest dollar.

| CERF Application for Grant Funding | [email protected] | cerf.un.org Annex B: Example of a Results Framework and Project Implementation Plan

Terminology - The project objective describes the overall objective to which the project will contribute. - Outcomes are longer-term changes resulting from outputs in one or more sectors. For single-sector projects, one outcome statement is recommended. The outcome statement should have a direct linkage to the overall project or programme of which the CERF project is part. - Outputs are direct and measurable products and results of activities. Indicate the output(s) to be expected upon completion of the CERF project, which should contribute to the outcome. There can be multiple outputs (no more than five is recommended) but they should be specific and achievable within the CERF project timeframe. - Indicators and Activities are assigned to a specific output. Indicators should be SMART. SMART indicators are: Specific, to avoid differing interpretations; Measurable, to allow monitoring and evaluation; Appropriate to the problem statement; Realistic and achievable; Time-bound, indicating a specific period of time during which the results will be achieved, which must fall within the CERF implementation period. Use the agreed cluster indicators in a Humanitarian Response Plan if possible.11 Each indicator shall have a measurable target assigned. - Activities are actions performed to achieve the outputs and outcome, such as the delivery of goods and services. Describe the activities for each output to be carried out under this CERF grant.

Below is a fictional example of a results framework and project implementation plan to be used as a reference. CERF Project Results Framework Project Improving the health of 2.6 million children and mothers at risk through MMR vaccination and primary objective health care in Zutaji and Lilango governorates in a six-month timeframe. Outcome Displaced and conflict-affected children and mothers protected against communicable diseases statement

Output 1 2.5 million vulnerable children in Zutaji and Lilango governorates have access to MMR vaccine

Output 1 Description Baseline Target Indicators 100% (485,000 Coverage of measles vaccination in per cent (among IDP children Indicator 1.1 0 girls, 515,000 under five in the two governorates) boys) 100% (800,000 Coverage of measles vaccination in per cent (among non-IDP school Indicator 1.2 0 girls, 700,000 children in grades 1-4 in the two governorates) boys)

Output 1 Description Implemented by Activities Activity 1.1 Procurement of 2.5 million MMR vaccine doses UN Agency Activity 1.2 Distribution of MMR vaccines to implementing partners UN Agency Implement vaccination campaign in cooperation with local NGOs and UN Agency, NGO1, NGO2, Activity 1.3 with community representation groups in each governorate Ministry of Health

Output 2 100,000 IDP mothers and children have access to health services for waterborne diseases

Output 2 Description Baseline Target Indicators 100,000 (30,000 Number of additional IDP mothers and children in all governorates mothers, 35,000 Indicator 2.1 provided with access to medical services for the control of waterborne 0 girls, 35,000 diseases boys) 5 health facilities Number of functional health facilities providing selected relevant 1 health Indicator 2.2 (1 hospital and 4 services (treatment of waterborne diseases) facility health centres)

11 If there is no HRP, use indicators from the Indicators Registry, which is maintained by the global clusters and available at https://ir.humanitarianresponse.info/

| CERF Application for Grant Funding | [email protected] | cerf.un.org Output 2 Description Implemented by Activities Procurement of medical kits and supplies for the prevention and Activity 2.1 control of waterborne diseases (100 IEHK, 14 diarrhoea kits, 200,000 UN Agency ORS) Distribution of medical kits and supplies to health facilities for 100,000 Activity 2.2 NGO3 IDP mothers and children Activity 2.3 Provision of medical services to 100,000 IDP mothers and children Ministry of Health

CERF Project Implementation Plan Project duration Se No De Fe Oct Jan p v c b 20 20 20 20 20 20 15 16 15 15 15 16 Ra pid Re spo nse Im ple me nta tion Per iod Underfunded Implementation Period Output 1 Activity 1.1 Activity 1.2 Activity 1.3 Output 2 Activity 2.1 Activity 2.2 Activity 2.3

| CERF Application for Grant Funding | [email protected] | cerf.un.org