UHAI EASHRI
PEER GRANTS APPLICATION FORM
ROUND 12
Proposal TitleAnticipated Project Start Date: / Anticipated Project End Date:
Grant Applicant’s Operating Name
By what name/s do you work and are you known
Long Name:
Short Name: / Grant Applicant’s Registration name (if registered)
Organisation Income in Last Financial Year
(in USD) / Organisation Budget in This Financial Year
(in USD)
Do you have a bank account? If not kindly note your fiscal host’s name.
ORGANISATION AND PROPOSAL INTRODUCTION
STAFFING AND BOARD INFORMATION
How do you identify the focus of your organisation?
Trans men: Trans women: Intersex persons:
Gender non conforming persons: Gay men: Bisexual men:
MSM: Lesbian women: Bisexual women: WSW:
Male Sex Workers: Female Sex Workers: Trans Sex Workers:
LGBTI: Mainstream: Other (please specify. You may use a combination that best desceibes you e.g. LBT Sex Workers):
Key Programme Leadership
Specify details of the following key programme persons who will be responsible for management and delivery of the proposed work
Organisation Lead
Name: Position: Cellphone #: E-mail:
Finance Lead
Name: Position: Cellphone #: E-mail:
Programming Lead
Name: Position: Cellphone #: E-mail:
Field Staff:
Name: Position: Cellphone #: E-mail:
Profile of Programme Leadership
Please describe the identities of your organisation’s leadership. A person can be more than one of these identities
Trans men: Trans women: Intersex persons:
Gender non conforming persons: Gay men: Bisexual men:
MSM: Lesbian women: Bisexual women: WSW:
Male Sex Workers: Female Sex Workers: Trans Sex Workers:
Youth (18-35 years): Persons living with disability:
Persons living with HIV: Persons who inject drugs:
Persons in informal urban settlements: Persons in rural areas:
Internally displaced persons: Refugees: Other, specify:
Primary Populations Targeted by your Organisation
Write YES against the population categories that apply to note which of the following constituencies are targeted with programming activities at your organisation
Trans men: Trans women:
Intersex persons: Gender non conforming persons:
Gay men: Bisexual men: MSM:
Lesbian women: Bisexual women: WSW:
Male Sex Workers: Female Sex Workers:
Trans Sex Workers:
Youth (18-35 years): Persons living with disability:
Persons living with HIV: Persons who inject drugs:
Persons in informal urban settlements: Persons in rural areas:
Internally displaced persons: Refugees:
Other, specify: Other, specify: Other, specify: / Primary Populations Targeted by programming planned in this Proposal
Write YES against the population categories that apply to note which of the following constituencies will be the primary/main targets for work that you propose here
Trans men: Trans women:
Intersex persons: Gender non conforming persons:
Gay men: Bisexual men: MSM:
Lesbian women: Bisexual women: WSW:
Male Sex Workers: Female Sex Workers:
Trans Sex Workers:
Youth (18-35 years): Persons living with disability:
Persons living with HIV: Persons who inject drugs:
Persons in informal urban settlements: Persons in rural areas:
Internally displaced persons: Refugees:
Other, specify: Other, specify: Other, specify:
Organisation History
Briefly describe in about 5 sentences when and why you were formed? For example what gap existed or still exists that you now have filled or are attempting to fill?
Past Work (If you are a new organisation and do not have any activities kindly leave this blank)
Organisational Programming Activities and Target Population/s
Highlight any four key activities that you have carried out as an organisation in the past, and for each activity please highlight the purpose behind the activity, which target population you were targeting with these activities, as well as the results [outcome and impact] of the activity.
1.
2.
3.
4.
Lessons Leant
Briefly describe in 3-5 sentences the lessons you learned over time. As you describe your learning, talk about any key achievements, critical failures and challenges and based on those any lesson learnt, that put you in a better position to handle this project this time.
1.
2.
3.
4.
Please select the type of peer grant you are applying for (Note that you can only apply for one grant type)
Grant Portfolio / Description of Grant Type
Msingi Grant / · These are up to one year foundational seed grants for initiating small scale initiatives.
· The ceiling for this grant type is USD 5,000.
· While both new and pre-existing UHAI grantees can apply for this grant portfolio;
o All pre-existing UHAI grantees applying for this grant are required to be up-to-date in reporting and accounting for any past or current grants with us. All applications from applicants who are not current in this regard will be automatically disqualified and will not be considered.
Tujenge Grant / · These are up to one year grants with a ceiling of USD 15,000;
· They are intended towards developing new large scale projects/activities and/or strengthening existing work;
· While both new and pre existing UHAI grantees can apply for this grant portifolio;
o All pre-existing UHAI grantees applying for this grant are required to be up-to-date in reporting and accounting for any past or current grants with us. All applications from applicants who are not current in this regard will be automatically disqualified and will not be considered.
Imarisha Grant / These are two year general support grants with a ceiling of USD 50,00 allocated as USD 25,000 per year;
They are geared towards:
· consolidating and sustaining organisations with longer term engagements and large scale activities and that
o have been in existence for a minumum of at least three years,
o have ever received funding from UHAI EASHRI,
o are up to date with reporting and accounting for their past grants with us,
o have a commendable fiscal responsibility,
o have a good track record of
§ absorbing funds on time,
§ and reporting and accounting for grants funds in good time.
As such all applicants applying for this grant portfolio have to submit:
§ their current strategic plan,
§ financial and procurement policies or manuals or their equivalent,
§ their latest audit report,
§ human resouce and administration policies or manuals.
Information on Funding Amount and Annual Organisational Budgets and Income
Organisational Financial Year start date
Day Month / Organisational Financial Year end date
Day Month
Annual Organisational Budget for the Previous Financial Year
(in USD) / Actual funds/income secured for the previous Financial Year
(in USD)
Annual Organisational Budget for this Financial Year
(in USD) / Aniticpated Funds for this Financial Year
(in USD)
Funds already Secured for this financial year
(in USD) / Contributions from other Donors to this Financial year’s Annual Budget
(in USD)
Total Funds Request from UHAI under this Proposal Request
(in USD)
Have you approached any other donor to cover work done under this project or any portion of it?
If yes kindly state which donor you have approached, what portion of funding you have requested from other donors and have received and for which activity?
Donor / Amount requested from donor / Amount receieved from donor / Activity for which funding was requested
Donor x / 1,000 / 500 / Core support
PROPOSAL DETAIL
Organisation Mission
In 1-2 sentences briefly state your organisation mission or goal
Membership Details, if any
If you are a membership organisation, in 1-2 sentences briefly describe your membership and size
Funding Purpose/Goal
State in 1-2 sentences the main long term aim or goal for this proposal request
Problem Statement
Please help us understand in 10-12 sentences what problem you seek to adress, what root causes created the problem and/or are sustaining/perptuating this problem. What are the effects of this problem and the consequences of not adressing it?
Proposed Objectives
Now that we have a clear understanding of the problem that you seek to address, and a clear understanding of your past experience and track record in addressing work, with that background clearly but briefly outline at most 4 objectives that you would like to achieve with this funding that will help you solve your problem. In developing your objectives kindly make sure that the objectives are specific, measurable, achievable, realistic and time bound. Please describe what you want to achieve.
Examples:
1. To raise public healthcare provider awareness on the reproductive health needs of female sex workers in Kinondoni.
2. To document the violence against trans people in Bujumbura.
1.
2.
3.
4.
Proposed Activities for this Project Request
For each of the objectives, please let us know in 1-2 sentences what activities you propose to implement that are in line with and will help you achieve the objective.
For each project activity, please be specific to include the target population(s), for what purpose you are targeting them and with what impact and outcome to the organisation and or community.
Objectives / Activity
Objective 1 / Activity:
Activity:
Activity:
Activity:
Objective 2 / Activity:
Activity:
Activity:
Activity:
Objective 3 / Activity:
Activity:
Activity:
Activity:
Objective 4 / Activity:
Activity:
Activity:
Activity:
Project Objective Outcomes
For each of the above objectives kindly summarise in one sentence the short term to medium term effects that you as an organisation or your target constituencies will experience as a result of the achievement of the above objectives. Who do you think will benefit from this project and how do you think they will benefit?
1.
2.
3.
4.
Organisational and Project Geographical Reach
As an organisation what is your ACTUAL and CURRENT geographical reach of MOST of your organisational activities?
For this Proposal request what will be your PRIMARY geographical FOCUS and REACH of your work?
Which areas of work will be supported by Requested Funding?
To be able to serve you better, and for monitoring and evaluation purposes of the thematic diversity of proposals that we receive and work that we support, we would like you to help us categorise the work/project/issues for which you seek funding for in this proposal submission.
What issues will the funding requested in this proposal address? Please focus on the key uses of the requested funds. You can select more than one key issue.
Kindly note that this list is not a finite list of thematic areas that the Peer Grants Committee prioritises when making funding decisions. We recognise that this list is not exhaustive of all the funding requests we have received, hope to receive, or have funded and hope to fund. We are also cognisant of the fact that this list might not be representative to some extent of how you define your work under this project in terms of language. In that regard, in case you would categorise your work any differently please tick on “other” and specify how you would categorise your work. Kindly note this data is for our Monitoring Evaluation and Learning purposes in order to help us serve our partners better.
1. [] - Institutional Strengthening and Core Support
2. [] - Legal and Policy Engagement, Litigation and Legal Representation
3. [] - Security and protection from violence
4. [] - Arts, Social Networking, Cultural Events and Spaces
5. [] - HIV, other health issues and wellness
6. [] - Human Rights Advocacy and Outreaches
7. [] - Other
Innovation and Effectiveness
Briefly describe in 3-5 sentences, what is unique about how you will do your work. What about your approach will ensure you meet your targets?
Partnerships and Collaborations
Briefly describe in 2-5 sentences the organisations/institutions/agencies that you will work with in this proposed work?
Describe the nature of your partnership/s and collaboration/s and the specific areas for partnership and collaboration.
Fundraising and Sustainability
What plans do you have and what progress have you made fundraising for this work? Are you working on other sources of support besides fundraising? E.g membership fees, income generating activities
ADDITIONAL REQUIREMENTS AND CLOSING STATEMENTS
Previous UHAI funding
List grant reference numbers and amounts for grants you have received from UHAI before. If unsure, please refer to your grant contract or ask us
Grant Reference Number / Grant Amount, in USD /
/ Grant Reference Number / Grant Amount, in USD
Additional Requirements / Please confirm by writing YES or NO that you have attached these additional requirements to your application.
1. [] - Proposal Budget [Mandatory for all grant applicants]
2. [] - Fiscal Host’s Latest Audit Report [Mandatory for all Imarisha grant applicants]
3. []- Grant Applicant’s Latest Audit Report [Mandatory for all Imarisha grant applicants]
4. []-Fiscal Host’s Finance and Procurement Manual/Policy- [Mandatory for all fiscally hosted organisations]
5. []-Grant Applicant’s Finance and Procurement Manual/Policy [Mandatory for all Imarisha grant applicants]
6. [] - Fiscal Host’s Administration/Human Resources Manual/Policy [Mandatory for Fiscally Hosted Imarisha Grant Applicants]
7. [] - Grant Applicant’s Administration/Human Resources Manual/Policy [Mandatory for all Imarisha grant applicants]
8. [] - Organisation structure/organogram/description of your leadership [Mandatory]
9. [] - Grant Applicant’s Registration Certificate: [Mandatory for all applicants receiving funds directly]
10. [] - Fiscal Host’s Registration Certificate: [Mandatory for all fiscally hosted grant applicants].
11. [] - Fiscal Hosting MoU: [Mandatory for all fiscally hosted grant applicants].
12. [] - Current Strategic Plan, if available [Mandatory for all Imarisha Grant Applicants]
Organisation References / Please provide a current recommendation letters from TWO organisations that can speak about your work. These should be on headed paper that is signed and stamped.
Name:
Relation to your organisation: / Position:
Organisation:
E-mail address:
Telephone #:
.
Name:
Relation to your organisation: / Position:
Organisation:
E-mail address:
Telephone #:
Confidentiality / Are there parts of this application that you would like to be kept confidential?
[] - If YES, please specify:
Feedback to UHAI EASHRI on grants application processes and support / What has your experience been seeking funding and support from UHAI and working with UHAI, and how can we better improve our application processes and support?
Declaration
The Organisation Lead should complete this section after reviewing the completed application. / I confirm that all the information in this application and required attachments is factual and correct.
Name, in the place of a signature:
Position: Date:
6