TIPH Temporary International Presence in Hebron
CONCEPT PAPERDate: Click here to enter a date.
1. Contact information and eligibility
Title of projectName of organisation
Contact Person
Address
Webpage
E-mail and phone
Registration in Ministry of Interior and legal Status / a. Registration number ______
b. Year of registration ______
c. Year of establishment______
d. Registration in other ministries______
e. Main bank account, including IBAN no:
Type of organisation / (a) For profit (b) Not for profit
(1) NGO
(2) Community Based Organization
(3) Government
(4) Research/ Academic Institution
(5) Other______
Affiliation to other organisations
Where is your organisation based, and where does it implement its work
Organisation’s goals and objectives
2. Description of project
General description of your projectWhat is the overarching goal and objectives of your project? Describe 3-4 specific results that your project aims to achieve.
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Describe your proposed strategies (a maximum 5) to achieve your overall goal and specific results.
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What is the link between the proposed project and TIPH’s mandate?
See: http://www.tiph.org/en/About_TIPH/Mandate_and_Agreements/
Theme of the project
(1) Youth/Sport
(2) Health
(3) Education, Training and Capacity Building
(4) Media
(5) Arts and Culture / (6) Economic Development
(7) Energy and Natural Resources
(8) Protection and Security
(9) Gender
(10) Other______
Need assessment
· Why is your project important for the well-being of the population of Hebron?
· What have you done in order to assess the need to implement your project?
Start date / End date
Click here to enter a date. / Click here to enter a date.
Time needed per activity
Describe the key networks/organisations/group/communities with which you will partner to implement your proposed project, and explain why
Please describe the possible challenges that you might encounter and how you plan to mitigate them
Please give us a short narrative that will illustrate the sustainable impact of your project
Specify the numbers of primary and secondary beneficiaries, male and female. Include a gender statement of how men and women will benefit from your project
Main characteristics of primary ‘beneficiaries’ (select all that apply)
Age
Children (0-9)
Adolescents (10-19)
Young (20-30)
Aged 31 to 59
Aged 60 and above / Social-Economic Level
Low
Medium
High / Location
H1
H2
3. Budget
Item / TIPH / Organisation / Other sources / Sub totalPersonnel
Technical assistance and training
Program Activity Expenses
Equipment
Travel and transportation
Other costs
Total
Note # 1: The organization’s contribution must be minimum 10% of total cost of the project.
Note #2: If this project is approved, the budget is merely illustrative and all costs must be substantiated by VAT-receipts to be considered for reimbursement.
Date and place ______
Name and signature______
Position______Organisation’s stamp