LMEF Concept Paper Application Form

LMEF Concept Paper Application Form

This Concept Paper Application Form must be completed in full; failure to do so will result in the Application not being considered. The maximum length of each section must be adhered to. Applications must be completed in Calibri font, size 11.

SECTION 1Applicant Information

PROPOSED ACTIVITY TITLE:______

LOCATION/S:______

DURATION OF THE ACTION:______

PROPOSED STARTING DATE: ______

ESTIMATED COST OF THE ACTION (N$):______

ESTIMATED BENEFIT OF THE ACTION (N$): ______

AMOUNT REQUESTED FROM MCA-N (N$): ______

NAME OF THE APPLICANT:______

TYPE OF ORGANISATION & REGISTRATION No.:______

COLLABORATIVE PARTNERS:______

______

______

CONTACT PERSON/S:______

POSITION IN ORGANISATION:______

TEL:______

FAX:______

EMAIL:______

POSTAL ADDRESS:______

______

SIGNATURE OF THE APPLICANT*______DATE: ______

* By signing this Application Form you certify that the content contained herein is a true reflection of the facts.

SECTION 2Proposed Activity Details

2.1Summary of the proposed activity(Max. 10 lines)

2.2Relevance (Max. 1 page). Please provide details on the following:

2.2.1How is the proposed activity relevant to the development of the livestock sector in Namibia’sNorthern Communal Areas, and why are these funds are needed?

2.2.2What are the problems to be resolved and the needs to be met?

2.2.3Does the activitybuild on previous studies/interventions, and if so,on which?

2.2.4Who are the beneficiaries and how will it benefit them? Please quantify if possible.

2.2.5What are the objectives and expected results/impacts?

2.2.6Do the benefits significantly outweigh the costs?

2.3Methodology (Max. 1 page). Please provide details on the following:

2.3.1What are the main activities?

2.3.2Explain your methodology with respect to the implementation of the above activities?

2.3.3Will the intervention have any multiplier effects?If so, provide details.

2.3.4Who are the main implementing partners, what is your relationship to them, and how will they be involved in the implementation of the research activities?

2.4Environmental impact and gender inequality (Max. 10 lines)

2.4.1Please provide any details you consider important with respect to either positive or negative environmental impacts.

2.4.2Please provide details on how this Concept promotes gender equality and equal opportunities.

2.5Operational capacity (Max. 15 lines)

2.5.1What is the legal status of your organisation and of that of your partner(s)?

2.5.2What is the experience of your organisation (and partner(s)) with the aspects to be addressed?

2.5.3What is the related experience and technical expertise of the members of the team? List three (3) previous projects similar in nature that your organisation has been involved in.

2.6Financial accountability

2.6.1Provide financial summary statements of your organisation(s) for the past three years.

2.6.2Is your accounting system computerised, and what programme do you use?

2.6.3When was your last financial audit conducted, and by which firm?

2.7Eligibility statement

A statement presented on your organisation’s letterhead and signed by the head of the organisation must be submitted together with this Application Form, stating the following:

2.7.1That the organisation is an eligible organisation, legally constituted under Namibian law,and with legal status;

2.7.2That the organisation has a management structure that includes appropriate staffing and a plan for appropriate on-going staff training and development;

2.7.3That the organisation has received a copy of the LMEF Grant Manual and that the Applicant’s management has read and understood its contents; and

2.7.4That the organisation confirms thatat the time of the Application no condition exists within the organisation or with respect to the organisation’s management that renders the organisation ineligible for a Grant directly or indirectly funded by either MCA-N or the Government of the United States.

APPENDIX IIof the MCA-N LMEF Grant Manual (April 2010)Page 1