Victim Empowerment Project

Grants for CSOs Providing Direct Services to Victims of Crime and Violence Application Form (VEP.1.2.13.11.2009)

Title of Project
Province of Implementation
District where CSO is based
Total Number of Months for proposed Grant
Total Amount Requested (ZAR)
  1. ADMINSTRATIVE DETAILS

Full Legal Name of Organisation / Acronym
Physical Address
Postal Address
Contact Person (including job title)
([]) / ([]) / ([])
Telephone Number / Fax Number / Cell Phone Number
Email Address / Alternate Contact Person and Email Address
  1. AGENCY STRUCTURE

Type of Organization
International NGO / National NGO / Academic Affiliated Institution / Community Based Organisation / Faith Based Organisation / Other (specify)
Date when the Organisation was Founded / Date when the Organisation was Registered
dd/mm/yyyy / dd/mm/yyyy
Registered as:
NPO / Trust / Section 21 / Other (indicate)
Registration Number
List of Governing Board Members (add more rows, if necessary)
Name / Position Held / ID Number / Contact Telephone Number and Email Address
Profile of Staff Working for the Organisation (add more rows if necessary)
Name / Full-time/Part-time/Volunteer / Position/Title / Years with Organisation
Formal Networks and/or Partnerships (add more rows, if necessary)
Partner Organisation / Type of Organisation / Years of Involvement
  1. ORGANISATIONAL PROFILE AND CAPACITY

Organisation’s Mission Statement/Objective
List the three main activities of the agency
1.
2.
3.
List ALL projects currently implemented and all implemented during 2006-2008 (add more lines if required)
From-To
(mm/yy) / Project Title / Sector(s) / Project Location
(town, district, province) / Donor (s) inc. contact name, telephone and email address / Total budget expenditure
What was the organisation’s total annual expenditure in the last financial year? (in ZAR)
______RAND
Is your organisation a recipient of DSD funding? Yes No
If so, how much?[1]
In 2008, RAND
In 2009, RAND
  1. BANKING AND FINANCIAL DETAILS

Account Name
Account Number
Type of Account
Full Name of Bank
Branch Name
Branch Code
Branch Address
SWIFT Code
Three Account Signatories (REQUIRED)
Name / Designation / Contact Details (telephone and email)

Grants for CSOs Providing Direct Services to Victims of Crime and Violence

PROJECT PROPOSAL

  1. BACKGROUND

Name of Organisation Submitting Application
Title of Project
Proposed duration of project (in months)
Total Amount Requested in ZAR
Proposed Start Date: (dd/mm/yy) 01 March 2010 / Proposed End Date: (dd/mm/yy) 31 December 2010
ESTIMATED BENEFICIARIES
Are the target beneficiaries for this project victims of crime and violence? Yes No
______Estimated total number of victims of crime and violence directly assisted through this project
Estimated breakdown of beneficiaries
___ Women / Youth (females 18-35) / Children (female) / Older persons (female) / Persons with Disabilities (male)
______Men / Youth (males 18-35) / Children (male) / Older persons (male) / Persons with Disabilities (female)
SECTOR / SERVICE TYPE
Sector specialization of this project. Check a maximum of three sectors. / Select all that apply
Gender Based Violence
Domestic Violence
Sexual Violence
Child Abuse
Psycho-social Assistance/Counseling
Perpetrator Interventions / Trafficking in Persons
Child Headed Households/Vulnerable Children
Shelter Services
Child and Youth Centres
Restorative Justice
HIV/AIDS / Societal Reintegration
Xenophobia
Health
Legal Assistance
Income Generation/Skills Development
Other (please specify) / Direct Assistance to Victims of Crime and Violence
CapacityBuilding
Research
Advocacy
Training
LOCATION
Check province(s) of project implementation
Eastern Cape / Free State / Gauteng / KwaZulu-Natal / Limpopo
Mpumalanga / Northern Cape / North-West / Western Cape
List specific districts of programme activities:
List specific cities or towns of programme activities:
Target area(s) are:
Rural Peri-urban Urban
Are activities targeting previously disadvantaged groups?
Yes No Describe?
ADDITIONAL INFORMATION
Is this proposal or a very similar proposal being submitted to other donors for their consideration? If yes, whom?
Yes No
  1. PROJECT DETAILS

Project Summary (A general overview the project and activities, in less than 100 words)

Problem Analysis/Rationale for project (Explain the problem and how/why you are seeking to address it, in less than 250 words.)

Overall Objective of project (What is the main purpose/goal you seek to attain with this project, in less than 50 words?)

Project Description (Provide a detailed description of project outcomes, outputs and activities, in less than 500 words, as detailed in the logframe on page 6.)

Monitoring, Evaluation and Learning Plan (M&EL Plan) (Detail your M&EL plan including a description of mechanisms for beneficiary feedback, in less than 100 words)

UNODC is committed to staff development within implementing organizations. Detail how you will increase the technical and/or programme administrative skills of staffin your organization,in less than 100 words.

UNODC is committed to promoting engagement between government and civil society. Describe how your organization will promote partnership and/or the exchange of information with governmentinstitutions, including involvement in local forums,in less than 100 words.

Partnership/Mentoring Plan (If application is for a partnership, provide a clear plan for how your organisation will implement the project as a partnership, including roles and responsibilities. If application is for a mentorship, please describe how you will increase the capacity ofyour emerging partner organization(s) and how you will effectively monitor progress, in less than 100 words.

Analysis of potential risks and how you intend to counter those risks (Detail any potential risks that could affect the effective implementation of the project, in less than 100 words.)

Sustainability Plan (Detail how you will make these activities sustainable after the completion of the project and any multiplier effect the project could have, in less than 100 words.)

Describe how your proposal meets with relevant victim empowerment policy (i.e. Victims Charter, Minimum Standards on Services for Victims of Crime, Shelter Strategy etc. (Please refer to relevant policy document(s), in less than 150 words.)

Visibility Plan (Details how you will promote the visibility of the UN Office on Drugs and Crime, European Union and Department of Social Development, in less than 100 words.)

  1. LOGFRAME (please copy if more outcomes needed). Based on the general information provided in the Project Description Section, please state each expected outcome and the activities required to achieve this outcome.

OBJECTIVE

Outcome 1:
Output / Activity / Indicator / Means of Verification
1.1
1.2
Outcome 2:
Output / Activity / Indicator / Means of Verification
2.1
2.2
Outcome 3:
Output / Activity / Indicator / Means of Verification
3.1
3.2

The following three outcomes as OBLIGATORY. Therefore you must complete them and include them in your proposal. The fourth outcome is applicable only incases on partnerships and mentorships.

ObligatoryOutcome 1: Effective monitoring and evaluation of project activities, for a cost not exceeding ZAR XXX.
Output / Activity / Indicator / Means of Verification
1.1
Obligatory Outcome 2: Enhanced staff capacity to manage and implement project activities, for a cost not exceeding ZAR XXX.
Output / Activity / Indicator / Means of Verification
2.1
Obligatory Outcome 3: Effective exchange of information / communication with government, for a cost not exceeding ZAR XXX.
Output / Activity / Indicator / Means of Verification
3.1

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VEP2009.1.2.13.11.2009.Application Form

  1. BUDGET (Please add rows and details as necessary. Please be as detailed and precise as possible. Please breakdown the total budget into proposed expenditure per quarter. Please note that you have the option of completing the document in MS word format below or in MS Excel which is also attached.

EXPENDITURES / Unit
Descrip-tion
(A/B) / No of Units (A) / No of
Units
(B) / Cost per Unit
(in RAND) / Total Cost
(in RAND) / % of Total Cost to be charged to project / TOTAL AMOUNT REQUESTED IN RAND / EXPENDITURE 2010
Q1:2010
Mar-May / Q2:2010
June-Aug / Q3:2010
Sept - Nov / Q4:2010
Dec
ADMINISTRATIVE COSTS / FOR ADMIN COSTS ONLY
1. Operational Staff (administrators, finance, logistics) / Person/month
1.1 List each staff member Indicate what percentage of their total salary will be charged to the project
1.2
1.3
SUBTOTAL Operational Staff
2. Transport (car rent, kilometer claim) / Contract/month
2.1
2.2
SUBTOTAL Transport
3. Public Transport (taxi, plane or bus tickets etc) / Person/#trips
3.1
3.2
3.3
SUBTOTAL Public Transport
4. Office expenditures (rent, electricity, water etc) / # of offices/month,
4.1
4.2
4.3
4.4
4.5
SUBTOTAL Office Expenditures
5. Office furniture and technical equipment / piece
5.1
5.2
SUBTOTAL Office furniture and technical equipment
6. Communications (internet, telephone postage) / Recharge/person/month or fee per person per month
6.1
6.2
6.3
SUBTOTAL Communications
7. Other Costs
SUBTOTAL Other Costs
SUBTOTAL ADMINISTRATIVE COSTS
PROGRAMMATIC COSTS
OUTCOME 1 / 100%
Output 1.1 / 100%
Output 1.2 / 100%
SUBTOTAL Outcome 1 / 100%
OUTCOME 2 / 100%
Output 2.1 / 100%
Output 2. 2 / 100%
SUBTOTAL Outcome 2 / 100%
OBLIGATORY OUTCOME 1: M&E / 100%
Output 1.1 / 100%
Output 1.2 / 100%
SUBTOTAL Obligatory Outcome 2: Staff Development / 100%
OBLIGATORY OUTCOME 2 / 100%
Output 2.1 / 100%
SUBTOTAL Obligatory Outcome 2 / 100%
OBLIGATORY OUTCOME 3 / 100%
Output 3.1 / 100%
SUBTOTAL Obligatory Outcome 3: Exchange of info with government/CSOs / 100%
SUBTOTAL PROGRAMMATIC COSTS / 100%
TOTAL PROJECT COST

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VEP2009.1.2.13.11.2009.Application Form

  1. WORK PLAN (Shade each area and include target numbers for each quarter to measure achievements against performance indicators per quarter per line item. Please add more rows as necessary. Include all outcomes and outputs, exactly as they are written in the logframe and the budget.

PROPOSED PERFORMANCE TARGETS / 2010
Qtr 1: Mar-May / Qtr 2: Jun-Aug / Qtr 3: Sept-Nov / Qtr 4: Dec
OUTCOME 1
Output 1.1
Output 1.2
Output 1.3.
OUTCOME 2
Output 2.1
Output 2.2
OBLIGATORY OUTCOME 1: M&E
Output 1.1
OBLIGATORY OUTCOME 2: Internal Staff Development
OBLIGATORY OUTCOME 3: Exchange of Information with Government

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  1. Checklist

Before signing and sending the application form, please check that your application is complete as follows:

Application is in English, type written using the approved grant application form (or neatly handwritten).

ALL sections of the grant application are complete and those sections or spaces that are not applicable have been marked “NA”.

Signed grant application, including proposal, budget and work plan (all sections complete). Using thisVEP2009.1.1.31.03.09.Application Form

Certificate of NPO registration

Last financial year’saudited financial statement and/or certified annual financial report (for newly registered CSOs who have not yet been registered long enough to be required to demonstrate NPO compliance, six months of bank statements are submitted).

CVs of Project Manager and any other key staff

Organogram (a diagram of your organizational structure)

Annex A: Certificate of Financial Integrity

Annual report (if possible)

Pamphlets and brochures (if possible)

Organisation meets all criteria below.

South African Non-Governmental Organizations, Community Based Organisations or Faith Based Organisations

Be a non-profit making legal entity

Be registered with NPO

Demonstrates compliance with registration requirements i.e. NPO registered CSOs must be able to demonstrate that the submitted annual reports to DSD NPO Directorate each year since registration

Have a headquarters in South Africa

Have representation and implementation capacity in target area(s)

Have an active decision making body, such as a board of directors or executive committee

Be directly responsible for the preparation and management of the action, not acting as an intermediary

Be able to provide proof of sound financial practises, i.e. audited financial statements

Organisation has previously implemented a project aimed at assisting victims of crime and violence

Target beneficiaries of the project are victims of crime and violence.

CSO is based in rural locations and/or in marginalized peri-urban and urban locations and/or underrepresented districts

CSO is only proposing project activities in one province, the province they are based in.

The proposed grant is of a duration of 10 months or less, with a start date of March 1, 2010 and an end date of December 31, 2010.

Amount requested is not over 350,000 ZAR

I am submitting four originals of the complete application.

Two originals were sent to UNODC Pretoria c/o VEP Grants Manager and two originals were submitted to my respective UNODC VEP Provincial Coordinator.

NOTE: Please read and complete this form with all due care. Omissions cannot be rectified and if any required information or documentation is missing, your application may be rejected.

  1. Declaration

I, the undersigned, being the person responsible in the applicant organisation for the action,certify that the information given in this application is correct.

Name:

Position:

Signature:

Date and place:

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