Application Checklist

Chemical Security Improvement Grant (CSIG)

Application Checklist

Please use this checklist to ensure that your application form is complete and contains all required documentation. Please note that your application will not be reviewed unless all application sections are complete and all documents are submitted.

☐ Application completeness:

☐ A. Completed Project Title

☐ B. Completed Applicant Information and List of Project Staff and Their Roles

☐ C. Completed Host Organization Information

☐ D. Listed Previous CRDF Global Funding (if any)

☐ E. Identified Expected Support for CSIG Project from Host Institution and/or other Non-CRDF Global Sources

☐ F. Provided a Project Description

☐ G. Listed Project’s Contribution to Chemical Security

☐ H. Complete List of Hazardous Chemicals that will be Secured by the CSIG (An example list of chemicals can be found at: OPCW Schedules of Chemicals I, II, and III , Australia Group Common Control List chemicals) or DHS Chemicals of Interest

☐ I. Identified Expected Outcome and Sustainability Potential

☐ J. Developed a Proposed Project Timeline

☐ K. Provided Supporting Documentation – i.e. photos of chemical facility, institutional support documents

☐ Budget (separate form) sections are complete and all line items are in the correct budget category:

☐ A. Listed Labor Costs, if Applicable

☐ B. Listed Equipment, Software, Material and Supply Costs

☐ C. Identified Other Costs, if Applicable

☐ Three vendor price quotes for each piece of equipment listed in the budget if over $5000, or if the vendor total is over $5000

☐ Curriculum Vitae (CV) of each project team member

☐ Copy of the passport face page for each team member on the project

Chemical Security Improvement Grant (CSIG)

Application

Instruction: Proposals may be completed in English, Arabic, or Kurdish. Completing the application in Arabic, Turkish or Kurdish will not negatively affect your opportunity of receiving a grant, but due to translation, doing so will add around two weeks to the response timeline for your application.

A. Project Title

Please provide a conscise and descriptive title.

B. Applicant Information

Title and Position:
First Name (as in passport):
Last Name (as in passport):
Country of Citizenship:
Name of Applicant's Institution:
Division or Department:
Address of Institution:
How many hours a week will the applicant work on the project?
Applicant's Contact Information
Phone Number:
Fax Number:
Email and Web:

Please list all other staff members who will be involved in the project.

Name, Title and Position / Specific Role in Project / Institution

C. Host Organization Information

Organization Name:
Division or Department:
Title & Name of Head/Chair in Charge of Authorizing this Arrangement:
Town/City:
Country:
Postal Code:
Phone:
Fax:
Email and web:
Institution and address where equipment will be installed and used:

D. Previous CRDF Global Funding

·  Has the applicant previously submitted a CSIG application?

a)  No

b)  Yes. Date of application: ______

Requested equipment or funding: ______

·  Has the applicant previously received funding from CRDF Global or participated in a CRDF Global training?

a)  No

b)  Yes. Number of times you received funding or participated in training: ______

Type and date of training/funding: ______

·  Please describe how you heard about CRDF Global and/or CSIG awards.

______

E. Expected Support for this Project from Host Institution and/or other Non-CRDF Global Sources

Add additional rows if necessary

Source of Support:
Amount of Support: / In-Kind* / Cash

*In-Kind Contributions are contributions of goods or services, not cash – i.e. computers, software, furniture, storage space, mail services, etc.

Signature of Applicant / Signature of Head in Charge of Authorizing Arrangement
______/ ______

F. Project Description

Please provide a detailed description of the proposed chemical security improvement project and explain what this project will achieve. Please outline all steps of the project from beginning to closeout including:

·  Your project objectives and goals (i.e. procure equipment, develop security procedures).

·  How you will implement your project – please include as many details as possible.

·  What is the main objective of your project?
·  What are the steps to be taken to ensure your project will accomplish its main goal?
·  Who will be involved in your project? What will be their responsibilities?
·  What is your role in the project?
·  What institution(s) will be involved in your project? Do you have support and the required approval to implement the project at each participating institution?

G. Contribution to Chemical Security

Chemical security refers to reducing the potential theft or diversion of hazardous or toxic chemicals for nefarious purposes. Please clearly explain:

·  How your project will enhance chemical security at your laboratory or facility.

·  Describe the current state of chemical security at your institution.
·  Please describe any perceived vulnerabilities, chemical security threats and areas for improvement (related to chemical security) at your institution or in your community.
·  Please describe any past security incidents including the theft or diversion of hazardous chemicals.
·  Please describe in detail how your project will mitigate or remedy the chemical security threats and vulnerabilities mentioned above.
·  Describe how the overall state of chemical security at your institution will be improved after your project is completed.

H. List of Hazardous Chemicals*

Please identify the hazardous chemicals that will be secured through this project.

*Priority will be given to those chemicals listed on the OPCW Schedules of Chemicals I, II and III or Australia Group Common Control List or DHS Chemicals of Interest.

Please provide the list of hazardous chemicals here under the applicable column heading.
OPCW Schedule I
Chemicals / OPCW Schedule II
Chemicals / OPCW Schedule III
Chemicals / Australian Group List Chemicals / DHS Chemicals of Interest / Other

I. Expected Outcome and Sustainability Potential

Please provide specific details on the immediate and long-term impacts your project will have on chemical security at your institution. Additionally, please explain how you and your institution will ensure sustained impact by maintaining security upgrades or procedures facilitated by your project after the granting mechanism is complete. Please explain:

·  The direct and indirect impacts of your project both short and long-term.

·  Who will benefit from your project and how will they benefit.

·  The institutional maintenance plan (i.e. equipment maintenance to ensure functionality).

·  How you will report the outcomes to CRDF Global (i.e. monthly reports, photographs, etc.).

·  What will the direct and indirect impact of your project be on both your institution and local community? Please describe the anticipated immediate and long-term impacts of your project.
·  Have you received financial support from your institution for long-term equipment maintenance?
·  Have you received long-term institutional support and buy-in required to sustain the impact of your project?
·  Please provide a detailed equipment maintenance plan, if applicable.
·  Please provide how you will report the outcomes of your project to CRDF Global.

J. Proposed Timeline

Please list each step/task for your project and the anticipated number of weeks or months to complete each step/task. The length of the project should not exceed six (6) months.

For Example:
·  Task 1: Equipment Order and Delivery – 1-2 months
·  Task 2: Equipment Installation – 1 month
·  Task 3: Training staff and students on new equipment – 2 weeks
·  Task 4:Preparing and submitting reports to CRDF Global – 1 month

K. Supporting Documentation

Please attach any documents in support of this chemical security improvement application such as: equipment information, letters of support from your institution, photos of your facility or laboratory if relevant, etc.

Appendix A - CSIG Project Budget Instructions

Please complete the separate budget document and submit it with your application

A. Equipment, Software, Materials and Supplies

Please list each piece of individual equipment, software, supplies and materials (one per line-item) you are requesting and include:

·  Price estimate in United States Dollars (USD) including value-added tax (VAT), delivery costs, and installation costs.

·  Description of equipment that includes the make and model of each item.

·  Expected country of purchase. If possible, applicants are encouraged to utilize local in-country vendors.

Please submit three vendor price quotes for each piece of equipment you list in your budget. Each price quote or bid usually comes in the format of a word document, invoice, PDF or printed or handwritten document that a vendor prepares for you, and has the costs itemized from each material, to VAT and installation costs.

B. Labor Costs

Please list individuals that will require payment in order to implement your project. For example:

·  Technician to install equipment.

·  Laborer to assist with construction of chemical storage building.

Limited labor costs for CSIG applicants will only be considered for funding if the project team member is required to install equipment or develop procedures. All requested labor and hourly rates will require a detailed justification and description of the individual’s role in the project. A small stipend for project team members in an advisory or administrative role will be considered on a case-by-case basis, however labor funding for CSIGs is limited.

C. Other Costs

Please list any extra costs outside of labor and equipment expenses that may be associated with the implementation of this project.

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