Engineers Without Borders

501B – New Project Within Existing Program ApplicationRevised 09/2014

Document 501B

New Project Within Existing Program Application

Chapter: Chapter Name

Country: Country Name

Community: Community Name

New project: New Project Name

Prepared By:

Names of report authors

Submittal Date

ENGINEERS WITHOUT BORDERSUSA

General Instructions:Submittal Deadline - The 501B – New Project Within Existing Program Application- will follow the same review cycle as the pre-trip reports and will be processed and reviewed within one month of the deadlines listed on the submittal deadlines table on our website. For example, if a 501B – New Project Within Existing Program Application-is submitted on Monday, February 14th (one day after the February deadline), the report will be processed and reviewed after the following month's deadline. In this example, this report would be processed and reviewed within one month of the March 13th submittal deadline.

Size Limit (10MB) - Please limit the size of the reports submitted to the EWB-USA Headquarters to a maximum size of 10MB. If you compress the photos within the document, this will help reduce the size of the entire document. If you do not know how to compress photos, please see our website for instructions. Please contact if you have special circumstances that may require a larger report submittal.

Section 1:Chapter Information

1.1Contact Information

Name / Email / Phone / Chapter Name
or
Organization Name
Project Lead #1
Project Lead #2
President
Responsible Engineer in Charge
Additional Mentor
Additional Mentor
Faculty Advisor (if applicable)
Education Lead
Planning, Monitoring, Evaluation and Learning (PMEL) Lead
In-country Community Contact
In-country NGO Contact
In-country Local Government Contact

1.2 Current Projects in Program: Please list all active and/or completed projects in this existing program and the phase of the project (assessment, implementation, canceled, or monitoring):

Project Type/Name / Phase of Project

(Note: In general, EWB-USA asks that chapters limit their number of projects to three for quality and funding reasons. Please contact your Chapter Relations Manager with any questions).

1.3How many people will be working on this new project?

Number of Students: ______
Number of Professionals: ______
Are all project participants members of EWB-USA? ____Yes ____No

1.4Professional Mentor Team: What experiences/education makes the Professional Mentor Team qualified for this new project?

Strength of Professional Mentor Team: The chapter has a team of professional mentors that include experience in each of the technical disciplines required of the project, construction, and international development. Additional detail on the professional mentor team requirements is included in the 405 - EWB-USA Professional Mentor Teams and Qualifications on the Sourcebook Downloads page of the EWB-USA website. Please note that the requirements for professional mentors apply to both professional and student chapters. Please complete the table below clearly specifying the roles of all professionals who will be part of the Professional Mentor Team. Review the 405 - EWB-USA Professional Mentor Teams and Qualifications available on the EWB-USA website before completing this section. For all design engineer roles, please specify the specific technical discipline that will be covered by that design engineer. All technical and non-technical disciplines required of the project should be included in the table. If one person will fill more than one role, fill in their name for each applicable role. Add and delete rows as necessary.

In addition to the table below, include the following with this application:

A completed 408 - Mentor Application Form (available on the Sourcebook Downloads page of the website) for each member of the Mentor Team
The resumes of all members of the Professional Mentor Team
A completed 404 - Mentor Statement of Intent (available on the Sourcebook Downloads page of the website) for the Responsible Engineer in Charge

Mentor Team Role / Name and Title
Design Engineer 1 – Responsible Engineering in Charge: (insert technical discipline here)
Design Engineer 2: (insert technical discipline here)
Construction Lead
International Development Lead

1.0Quality Management Planning – The quality of each EWB-USA program is the responsibility of the chapter that has adopted the program. Please describe the measures the chapter will take to ensure that the projects implemented under this program are of high quality by addressing each of the areas below.

1.1Statement of Quality Management Plan: Please provide a brief statement about the methods that the chapter will employ to ensure that the documents submitted to EWB-USA HQ for review will be a high quality document. EWB-USA will not dictate the methods that should be used for this quality management. Each chapter is expected to develop a quality management plan based upon the resources that they have available to them and the specifics of the program they are working on.

Example methods that could be part of an overall quality management plan could include the following: 1) The chapter may use an independent peer review team to review key documents prior to submittal to EWB-USA HQ; 2) The chapter could require specific training and/or minimum education requirements for members of the project team (refer to training/education information in Section 6.0 of this application as necessary); 3) The chapter will establish a review schedule that provides time for reviews by the peer review team, mentors, community, and other local partners and regulatory agencies; 4) The review schedule will include time for review by the local NGO and CBO of the Alternatives Analysis (523) and Preliminary Design (524) Reports; 5)The chapter will do a post mortem review of each document that they have reviewed by the EWB-USA HQ or TAC to determine how they could have improved the document;6) The chapter will keep a lessons learned log to ensure that mistakes are not repeated;7) The chapter will use design standards that have been approved for the area, etc. Note that there are many other things that could be part of a quality management plan for a chapter and can be included here.

1.2Quality Management Team Staffing:Please describe the roles and responsibilities with implementing the team’s quality management plan. Potential Quality Management Team Members could include: professional mentors, peer reviewers, community leaders, local partners, local government agencies, etc. Specific names do not need to be included in the table below. The Description of the Quality Management Roles should include review responsibilities at a minimum.

Quality Management Team Member / Description of Quality Management Roles

1.3Review Requirements: Please use the following table to indicate the level of review in terms of personnel and time that your team will follow for each EWB-USA submittal. It is expected that these reviews will occur before submitting your document to EWB-USA. The team should use this information to begin mapping their overall project timeline.

EWB-USA Document / Reviewer(s) - review time needed
Example (to delete before submittal of application)
524 – Preliminary Design / Water Supply Mentor – 1 week
International Development Mentor – 1 week
Water Committee – 3 weeks
Municipality – 3 weeks
Peer Review Team – 1 week
521 – Pre-Assessment Report
522 – Post-Assessment Report
523 – Alternatives Analysis Report
524 – Draft Final Design Report
525 – Pre-Implementation Report
526 – Post-Implementation Report
530 – Pre-Monitoring Report
531 – Post-Monitoring Report

Section2: New Project Information

2.1New Project Location

2.1.1Is this new project in a community which your chapter has not previously worked in within this program? ____ Yes ____ No (if No, continue to 2.2):

If Yes:

2.1.2New Community Name: ______

2.1.3Location in Country (e.g. South West Kenya, 30 miles from Tanzania): ______

2.1.4New Community Geographic Coordinates: Google Earth may be used to determine coordinates. Care should be taken to get the relative direction for the latitude (E/W) and longitude (N/S). Please use N, W, S, or E as a prefix to indicate the relative direction from the equator or Prime Meridian. For example:S 44.0354, W 98.3342.

2.2 New Project Title:______

2.3Criteria for Expanding to Additional Communities

2.3.1The communities are in the same region? ___Yes ___No

2.3.2The communities are within the jurisdiction of the same local level of government (i.e. the same municipality)? ___Yes ___No

2.3.3The project team can easily access both communities in the same trip? ___Yes ___No

2.3.4The community has requested the project? ___Yes ___No

2.3.5The project will have the same NGO Partner or Professional Mentor? ___Yes ___No

2.3.6Project monies will be managed in the same account? ___Yes ___No?

2.4New Project Summary: Provide a short overview of the scope of work of the proposed new project.

One-Two paragraphs. Approximately 75 words

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501B – New Project Within Existing Program Application

2.0

2.1

2.2

2.3

2.4

2.5Project Discipline(s): Check the specific project discipline(s) addressed in this application. Check all that apply

501B – New Project Within Existing Program Application

Water Supply

____ Source Development

____ Water Storage

____ Water Distribution

____ Water Treatment

____ Water Pump

Sanitation

____ Latrine

____ Gray Water System

____ Black Water System

Structures

____ Bridge

____ Building

Civil Works

____ Roads

____ Drainage

____ Dams

Energy

____ Fuel

____ Electricity

Agriculture

____ Irrigation Pump

____ Irrigation Line

____ Water Storage

____ Soil Improvement

____ Fish Farm

____ Crop Processing Equipment

Information Systems

____ Computer Service

501B – New Project Within Existing Program Application

2.6Affected Population: How many people will be affected by this new project in a certain geographic region (please provide an estimated numberof people affected -- not a description)

2.5

2.6

2.6.1Directly Affected: ______

2.6.2Indirectly Affected: ______

2.6.3Geographic Area (5km radius, town, region etc): ______

2.7Detailed New Project Description:Provide a more detailed description of thenew project. What is the community’s goal forthe new project’s outcome? How will it improve the living conditions of people in the community?

One-Three paragraphs: Approximately 300 words

Revisit the 501 for the program. In the table below, update the community-stated goals by checking the elements of change in the community that EWB-USA’s project involvement might affect:

EWB-USA Change Element / Community Goal (indicate with an X)
Change in public health
Change in environmental health
Change in behavior
Change in access to services
Change in technical knowledge related to projects
Change in community organization
Change in community self-advocacy

2.8Background: What is the cause and history of the problem? What solutions have been tried in the past to address this problem? What were the results? What are the barriers to implementing a sustainable solution to this problem? If any efforts were made, please describe the outcome.

One-Three Paragraphs: Approximately 200 Words

2.9Positive Impacts: What potential positive impacts are anticipated as a result of this new project? Please consider health, economic, environmental, social and cultural effects.

One-Two paragraphs: Approximately 100 words

2.10Negative Impacts: Every project has negative impacts as well as positive impacts. List negative impacts that you have considered to be potential consequences or outcomes of this new project. Please consider health, economic, environmental, social and cultural effects. (Note: We require that you answer this question – it will reflect the level of analysis put into this new project). How will these potentially negative impacts be addressed?

One-Two paragraphs: Approximately 100 words

2.11Project Ownership: Who is expected to own this proposed new project? Will a committee be established? Who will manage and be responsible for the maintenance and repairs of the new project?

One paragraph: Approximately75 words

2.12Capacity Training: What training of local community members will be required in order to maintain and/or repair the new project? What specific educational training will be offered? Will verbal or written translation be needed for this education? Who will be translating? If written materials are proposed, in what language will they be offered? Do you have information on the community’s literacy level? Would pictorial materials be more appropriate?

One-Two paragraphs: Approximately 75 words

2.13Budget:If an estimated project budget has been developed, please include the figures below:

Estimated Cost
Labor / $
Materials / $
Equipment / $
Total / $

2.14Criteria for NGO Owned Facility Proposals: For program applications which are being submitted by or on behalf of an NGO Owned Facility such as an orphanage, school, or health clinic please see Appendix A – Criteria for NGO Owned Facility Projects. Responses to how these criteria will be met must be included in Appendix A of this application.

2.15Community Statement of Intent: Submit the signed Community Statement of Intent (last page of this application) as an attachment.

The community of ______agrees to:

communicate with the EWB-USA chapter contacts directly and frequently, as determined by the project schedule, including feedback throughout the assessment and design process;

contact the EWB-USA chapter contact immediately to discuss any changes in priority projects or the project scope;

identify community contacts to accompany the EWB-USA chapter during site visits;

make a cash contribution of a minimum 5% of the capital construction costs for each project within the program before construction begins;

provide in-kind contributions at no cost to the EWB-USA chapter (examples are labor, local materials, transportation of materials to the site, etc.);

develop and present to the EWB-USA chapter a system for management and funding the long term operations and maintenance of the project before construction begins;

pay for all operations and maintenance upon project completion and in the future;

ensure that all implemented project(s) in this program represent community-wide priorities and that all community members will have the opportunity to benefit from the project per the terms of use established by the community.

In addition to this Community Statement of Intent, the applicant community, EWB-USA, and the local partner (NGO or municipality) will sign a general Project Agreement after the first assessment trip. The final Implementation Agreement, including the roles and responsibilities of all parties to the agreement during the construction and ongoing maintenance phases, will be signed prior to the beginning of construction.

On behalf of, and acting with the authority of the residents of the applicant community, the under-signed agrees to the requirements stated above.

______

SignatureDate

______Printed Name E-mail Address Mobile phone number

______Role in the Community

Please submit this application electronically via email to the EWB-USA Projects Staff at ().

Appendix A: Criteria for NGO Owned Facility Projects

This section must be filled-out if the proposed project is for any facility that will be owned by an NGO, such as a school, orphanage, or health clinic.

Background

One of the key principles of EWB-USA’s community development model is that we support community-driven and community owned projects. Given this approach to community development, NGO owned facilities present a unique challenge to our organization because they are distinct from our other projects. First of all, these projects are typically funded by a local or international NGO. In addition, this NGO is typically advocating on behalf of a group of people who access the facility, such as children; however, this group may not be driving the proposed project or partnership with EWB-USA. Finally, the ultimate ownership of the project is not with a community, but rather ownership lies with the partner NGO. While EWB-USA will continue to partner with these type of projects, we are concerned about their viability and sustainability, especially if outside donor funding is discontinued. Given these circumstances, as well as our desire to ensure the long-term sustainability and success of all projects, we have identified a specific set of requirements for NGO owned facility proposals.

Instructions

The applicant should provide responses to each of the criteria below. If the response to any of these criteria has already been addressed in the application above, please restate it here.An application related to this type of facility will not be considered complete if the criteria have not been addressed.

NGO must demonstrate its past and future commitment to the facility, including financial support.
NGO must demonstrate that the facility is, or will be, legally registered and will be monitored by a government agency.
NGO, in collaboration with facility staff members, must demonstrate support for the proposed project, including taking primary responsibility for all operation and maintenance costs and logistics.
NGO must explain the plans for providing skilled and/or unskilled labor for the proposed project.
NGO must provide plans for the participation and engagement of the members of the surrounding community, if applicable.
NGO must contribute a minimum of 5% cash towards the upfront construction costs of the proposed project(s). This is the same requirement for all EWB-USA projects.
Any existing community linkages, such as Parent-Teacher Association or community support organizations, should be identified in the application. If possible, endorsements from these organizations should accompany the application.