(To be completed by Smile Foundation only)
Project Application Form
Smile Foundation
To be completed in EnglishProject Name
Name, Address and full contact details of NGO (and it’s Chief Functionary)- implementing child-focused Project- (for whom fund is proposed to be raised)
Name of the Applicant (Local Initiatives/ NGO) proposing to raise fund for a particular child-focused project
Brief of child- focused Project for which fund is proposed to be raised:
Location (District/State) [Give the name of city / town, and/ or village(s) where the project will be implemented.
Include a (copy of) a map of the project area, indicating the area/places where activities will take place, as Annex I to this application].
Duration of the project :
Starting date :
Target No. of Children/women/ others
Services provided
Project Budget and Coverage
Details / Local currency (INR)Total amount
Own contribution by the Applicant (only cash contribution, do not include contributions in kind)
Contribution of other donors (name them)
Requested contribution from SMILE
- Goals/Objectives
[What aim/goal does the project hope to achieve. Objectives are quantifiable parameters which aid in achieving the goals.]
2.Contribution to achievement of Millennium Development Goals
[Please mention to which Millennium Development Goals (MDG) the project is related (or several, if applicable), and how the project will contribute to its achievement?]
3. Justification of the project and description of the target group
a) Subjects being addressed through the project like education/health/vocational studies/or any other & reasons which describe the need for the project.
Please provide the following information:
b. Identification of the needs and constraints of the target group(s)/ intended beneficiary
c)Description of target groups
Social category and economic situation-Intended beneficiaries of Fund raising initiative
Age group
Estimate of anticipated number of direct beneficiaries (give a approx number)
Gender:what percentage of the direct beneficiaries are women/girls? (in% )
Disability:What percentages of the direct beneficiaries are with handicap (Type)? (in% )
Location:what percentage of the direct beneficiaries lives in a rural area and what percentage in an urban area? (in%)
4. Strategies & activities
[Ways & means by which the stated goals & objectives of the project will be achieved].
Detailed description of activities
[Describe the concrete activities that will be undertaken to achieve the expected results of the project (think of: “Who will do what and when?” Please number the activities]
Activity (“What”) / Responsibility (“Who”) / Time of implementation (“When”)5. Dissemination plans
{How will the findgs, feed back, learning & experiences of the project be known to other people}
6. Indicators to assess impact
[Parameters against which project progress can be measured]
7. Expected results
a. [Please give precise details and quantify the results as far as possible WHAT and FOR WHOM (“access obtained to primary education for 120 children”; “access obtained to clean drinking water for 2,400 families”; OR “ “mother-child care for rural area with 3.000 inhabitants, estimated number of 400 consults each year” etc.]
b. Please also fillthe information in the given tabular format
OBJECTIVE / ACTIVIGTEIS / INDICATORS / OUTCOME6. Financing Aspects and Managing Sustainability
a)Please describe who will be responsible for continuing and managing the
activities once financing has come to an end, the local partner/ target group/ other body?
- Detailed Budget for the project (Excel Sheet)
[Month wise/Quarterly, annual budget in tabular form with major heads of expenses. The break up of items under each head to expense will also be mentioned.]
Details of NGO implementing Child focused Project
8.0Description of the NGO implementing child-focused Project- (for which fund is proposed to be raised)
Name & Address
Phone No.Fax No.
8.1Date established & legal status (including Act and official registration number, where relevant)
8.2 Official address, Contact phone of Chief Functionary
8.3 Main objectives and activities of the organisation
8.4 List of members of the management committee/Board of directors of your organisation with full contact address, phone, e-mail and their profession.
8.5 What is the relation of your organisation with the organization who is submitting / has submitted fund raising proposal for your project?
8.6 Are you aware of fund raising proposal submitted by ------
------for supporting your project?
8.7 Did you approach them for fund raising support?
8.8 Have you utilized their help through fundraising initiatives in the past? If YES, provide details such as type of fundraising initiatives successfully executed by them in past, fund raised and utilized for the purpose.
9. References
Please give the names, addresses, telephone numbers and e-mail accounts of persons who can be contacted by SMILE FOUNDATION for reference purposes.
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Signature of Chief FunctionaryStamp
Date:
Place:
Checklist of annexes
Before sending off signed paper copies of your application, check carefully that it is complete and correct.
A map of the project area
The statutes of the applicant organisation
Statement of official registration of the applicant organisation
Annual or activity report of the applicant organisation for the last year, including Financial Statements (and audit report if available)
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Project Application Form Smile Foundation 2008