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Vienna International Centre
P.O. Box 500, A-1400, Vienna, Austria
Telephone: +43-1- 26060-0 Telefax +43-1-26060-5866
E-Mail:

In order to consider your application for a grant to organize and maintain a regional youth network, we would like to have the following information about your programme. Please fill the questionnaire and send it to:

GAUTAM BABBAR

UNODC Prevention, Treatment & Rehabilitation Unit

P.O. Box 500 A-1400 Vienna AUSTRIA

Telephone (43 1) 26060 4244

Fax: (43 1 ) 2606074244

e-mail:

or

Ms Giovanna Campello

UNODC Prevention, Treatment & Rehabilitation Unit

P.O. Box 500 A-1400 Vienna AUSTRIA

Telephone (43 1) 26060 5551

Fax: (43 1 ) 2606075551

Email:

  1. Name of the programme:
  1. Address:

Telephone:

Telefax:

E-mail:

  1. Contacts

Key contact person (name and title):

Chief of the organization (name and title):

  1. What are the objectives / goals or your programme?
  1. Who is your target group:

Age:

Gender:

  1. Please describe your programme in a few lines, not more than 300 words
  1. Which activities are related to drugs?

______

  1. Do you have other areas of activities? If yes specify:

______

  1. How many people benefit from the activities of your programme?

______

  1. Please describe your Organisational Structure: ((how many people? How many volunteers, staff? Board/ governing body), add a diagram if you want. (Not more than 300 words)

______

  1. Please describe your financial accounting structure (any accountants/ auditors or compliance mechanism you may have in place)

______

  1. Please describe the facilities you have at your disposal (such as a building/ rooms, computers, internet, any vehicles, training equipment etc) that can be used to help create and run a regional youth network. (Not more than 300 words)
  1. In which way do young people participate in the programme? How many of the people mentioned above (i.e. in the organizational structure) are less than 24 years of age, please give their names and what do they do
  1. Please describe how and in what ways you have been working with other GOs/ NGOs in your country and your region (no more than 300 words)

______

  1. Have you been involved with any international initiatives on youth and substance abuse? If so, please describe in no more than 150 words.

______

  1. Please describe what you would do (and why!) to: 1. Set up a network of organizations working on substance abuse prevention in your region and 2. Run the network (not more than 400 words)
  1. Your programme was founded in:
  1. Your sources of income are:
  1. Annual budget in US$: please attach audited balance sheets if available
  1. If your programme has produced any promotional material or any publications or if you have any official reports or evaluations of programmes conducted by you, please attach them to this form and send them to us.