DETAILED INFORMATION

Please complete this form in MS Word format (do not convert to PDF) and email to the Embassy’s Public Affairs Section at .

Legal Name of Applicant (Individual/Organization):

Project title:

Main point of contact

Name:

Designation:

Phone number:

Email:

PROJECT DETAILS:

Please enter all necessary information regarding the proposed project below. In this part please give as many details as possible.

Area of interest (more than one selection is allowed):
Youth empowerment / Environmental Protection & Conservation / Trafficking in Persons
Countering Violent Extremism (CVE) / Arts & Culture / Entrepreneurship
English & Education / Gender issues / Women empowerment / Freedom of Press
Others (please specify):
Purpose of Project:
Purpose should include a summary of the project’s goal and major activities. Please stay under 150 characters. A more complete description should be entered below.
Project objectives
Please state the project objectives.
1.
2.
3.
Project Description:
Please provide a narrative outline of your project. Describe the project, what it will accomplish, and how it will achieve these goals. If appropriate, describe the people who will benefit and how. The description should be informative to other persons working in the same or related fields and insofar as possible understandable to a technically literate lay reader.
Project Outcomes and Major Activities:
What are the major activities that will be carried out throughout the program (E.g: 2 x workshops, Website development, launch event)? What outcomes do you expect in terms of both short-term results and long-term outcomes and processes that may be set in motion by the project?
Statement of Need:
Please state the funding amount requested in USD or MYR. Also explain why you are seeking U.S. Embassy funding for this project and what, if any, other funding sources are anticipated.
Project Timeline:
Please state when the event or activity will take place and when funding would be needed. Also list here the major action steps you will take in order to carry out this project with an approximate date of completion for each step to provide a picture of the project timeline.
Project period
Start date:
End date:
Project timeline
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Project Partners:
Please give the name and key function of all partner institutions.
Target Audience:
Description of Audience
Expected Number of Individuals Reached* / Cities or Regions Reached

*Please list the numbers of individuals reached by categories such as: attendees, implementers, print readers, broadcast viewers, etc.

DETAILED BUDGET

Please include your cost in this project and funding from other sources.

Detailed Budget:
Please provide a detailed budget with line items for this project, including funding from other sources. Budget sheet should be submitted as a separate document.

When the grant contract is successful please be aware that:

The Embassy logo and name, needs to be shown in all material corresponding to the grant. This includes programs, educational material, and posters. Banners indicating support by the Embassy needs to be displayed at all events.

Contact Information

For further information, please contact Ms. Chin Su Ci, Tel: 03-2168-4976 or the Embassy’s Public Affairs Section at