For Office Use

Application Number: ______

Date Received:______

Grant Application

Youth Solutions! Technology for Skills and Employment

Sri Lanka

Executive Summary (Please type using no more than two pages)

  1. Date:
  2. Name of organization:
  3. Contact person and title:
  4. Address:
  5. City, Country, Postal Code:

6.  Telephone:

Fax:

Email: Website (if available):

  1. What is the mission statement of your organization/group?
  2. Please provide a snapshot of what you are trying to achieve. Focus on the issue (the need for specific development), the solution (your project idea using ICT innovation), and the impact. What is your target population and how many people do you estimate will benefit from the proposed activities?
  3. What it the expected outcomes of your proposed project?
  4. Please outline your plans for learning and knowledge sharing.
  5. Tell us why you will be able to implement your proposal.
  6. How is your project idea innovative? How does it differ from other initiatives in place?
  7. What is the potential for the sustainability of your project? How do you think your project can be replicated beyond the initial phase?
  8. What is the period this funding request will cover? Outline key milestones/timelines and associated activities.
  9. What is the amount of your grant request? Please provide detailed breakdown in the Budget section below.
  10. If your organization has received previous support from the World Bank, please list the year, amount, and describe for what purpose:

17.  Authorizing signature of the applicant organization’s executive director or board chair:

Signature:

Name (print): Title:


Budget for the Proposed Activity

Please (1) provide the necessary information for each budget item, and (2) indicate the funding source(s) that will cover the expense. Use as much space as necessary. All items must be related to the activity.

Item / Contribution from Applicant / Contribution from Other Donors / Contribution from the proposed Grant / Total

Please note: World Bank funding is not allowed for equipment.

Attachments

Please attach the following documents to your proposal, if available:

ü  Complete list of the applicant organization’s senior staff and board of directors;

ü  Most recent annual financial statement listing income sources (audited if available);

ü  Organization’s projected income and expense budget for current fiscal year, listing income sources;

ü  Copy of the applicant organization’s registration status;

ü  Latest annual report or publication providing an overview of the organization’s work.

Submision

Project proposals from youth-led organizations in Sri Lanka should be submitted to:

Ms. Dilinika Peiris-Holsinger

Communications Associate

World Bank Office Sri Lanka

73/5, Galle Road

Colombo 3, Sri Lanka.

email: