Form 1: VAST Proposal Application

VAST Guidance - Volunteers / 2010

Form 1: VAST Proposal Application

Volunteer Activities, Support and Training (VAST) Program

PROJECT PROPOSAL – Once Approved, submit to OAR subject heading: VAST Proposal

Project summary

Country:

VAST Project Title:

Community Organization:

Implementation Period: From: To:

Volunteer Name (s) : COS Date:

B. Project Description

HIV/AIDS Program Area Budget Code (choose one):
 Abstinence, be faithful (HVAB) /  Other prevention (HVOP)
 Basic health care & support, Nutrition (HBHC) /  Orphans & Vulnerable Children (HKID)
 Organizational CapacityBuilding (OHSS) /  Counseling & Testing (HVCT)

C. Project Goal(Please write one concise statement on the goal of this VAST project.):

D. Project Objectives(Please write out each objective for your project. All objectives should collectively meet the above goal. Please keep # of objectives to 4 or less.):

1.What methods will you use to evaluate the success of your project? (e.g. focus groups, interviews, observations) Please describe for each objective.

E. Sustainability(Please provide a brief explanation to the following questions.):

What community-identified priority does this VAST project address?
How will this project build skills within the community or local organization?
How will the community or local organization be able to sustain the benefits of this project?

F. Do No Harm(Please provide a brief explanation to the following questions.):

What are the potential negative effects of this project (environmental, social, political, or economic)?
For each of the effects listed above, please describe the steps the community or local organization will take to mitigate them.

Indicators & Targets:

The below indicators & age breakdowns are what Peace Corps uses for PEPFAR reporting. Your project may address only 1 or2 areas. Please fill out ONLY the relevant indicators and then tally the total.

Abstinence and Being Faithful
AB Indicator / # Men (25 & >) / # Youth Boys (15-24) / # Boys (<15) / # Women (25 & >) / # Youth Girls (15-24) / # Girls (<15) / Total
# Of people who will receive HIV prevention interventions primarily focused on abstinence and/or being faithful.
Other Prevention
# Of people who will be reached with individual and/or small group level HIV prevention interventions.
Other Prevention - Most At-Risk Populations
# Of MARPs who will receive individual and/or small group level HIV preventive interventions.
Care - One Care Service
Care - One Care Service / # Men (25 & >) / # Youth Boys (15-24) / # Boys (<15) / # Women (25 & >) / # Youth Girls (15-24) / # Girls (<15) / Total
# Of eligible adults and children who will receive a minimum of one care service.
Care- Food and/or other Nutritional Service
# Of eligible adults and children who will receive food and/or nutritional services.
Human Resources for Health (HRH)
HSS- Human Resources for Health (HRH) / # Men (25 & >) / # Youth Boys (15-24) / # Boys (<15) / # Women (25 & >) / # Youth Girls (15-24) / # Girls (<15) / Total
# Of health care workers who will successfully complete an in-service training program within the reporting period.
TOTAL:
Total Estimated Beneficiaries to be Reached / # Men (25 & >) / # Youth Boys (15-24) / # Boys (<15) / # Women (25 & >) / # Youth Girls (15-24) / # Girls (<15) / Total
# Of individuals and/or service providers who will be assisted or trained by this VAST project

Project Budget:

Volunteer Name: / Project Title:
PROJECT COST BREAKDOWN IN US Dollars
Category / VAST Funds / Community Contribution / Third Party Contribution / Third Party Name / TOTAL
Cash / In Kind / Cash / In Kind
Labor
Equipment
Materials/Supplies
Venue Rental
Travel/Per Diem
Transportation of Materials
Other
TOTAL
Resource Descriptions:
Category / Description
Labor
Equipment
Materials/Supplies
Venue Rental
Travel & Per Diem
Transportation of Materials
Other

Form 2: Consent & Liability

VAST - CONSENT AND LIABILITY ACCEPTANCE

Peace Corps Volunteer or Community Organization Official/Counterpart

(To be filled out and signed before funds are transferred to the Volunteer or Community.)

By signing this statement, I agree to accept VAST funds on behalf of the Community Group / Organization listed below, and for the purpose of implementing VAST Project Title ______. I assume responsibility for managing these project funds in accordance with VAST Program guidelines, and for obtaining the necessary original invoices and receipts for all purchases or expenditures made in connection with this VAST Project. At the end of the Project, I will account for the use of these funds by returning all allowable receipts and any remaining cash to the Peace Corps Office.

To the extent possible, all purchases and payments drawn against the VAST Project will be made by ElectronicFunds Transfer (EFT) or cash ordered through Peace Corps. To decrease my own personal liability, I will work closely with my community or organization to establish a funds management system and/or community or Project bank account and, when possible, utilize bank transfers for major purchases. For any and all purchases or payments made with VAST funds, I will obtain a signed, dated, and witnessed receipt, and record the expenditure in the VAST Project Log.

I understand that any loss of VAST funds under my control, due to negligence on my part in not following these stated requirements, may result in me being held accountable to repay all, or a portion, of the VAST funds.

I further understand that my liability to the Peace Corps with respect to this Project is limited to the management of funds secured through the VAST Project.

Local Organization Name:
Organization Official / Peace Corps Volunteer
Signature: / Signature:
Printed Name/Title: / Printed Name:
Date: / Date:
Post Administrative Officer
Signature:
Printed Name:
Date:

Form 3: Project Agreement

VAST Project Title:
Community Organization:
Implementation Period: / From: / To:
Volunteer Name / COS date:
Budget Summary: / Percentage of Project:
Local Contribution / USD / Local Currency / %
VAST Amount / USD / Local Currency / %
Total Project / USD / Local Currency / %
HIV/AIDS Program Area Budget Code (choose one):
 Abstinence, be faithful (HVAB) /  Other prevention (HVOP)
 Basic health care & support, Nutrition (HBHC) /  Orphans & Vulnerable Children (HKID)
 Organizational CapacityBuilding (OHSS) /  Counseling & Testing (HVCT)

Authority:

IN WITNESS WHEREOF, the COMMUNITY ORGANIZATION listed aboveand Peace Corps, pursuant to the terms and conditions of the Memorandum of Understanding and Implementing Instrument referenced above, each acting through its respective duly authorized representative, have caused this VAST Project Agreement to be signed in their names and delivered as of this date and year.

Signature: / Signature:
Name: / Name:
Title: / (Community Organization Official) / Title: / (Peace Corps Country Director)
Date: / Date:

Administrative Unit:

Approved for obligation: / Administrative Officer:
Fiscal coding:
Obligation number: / Vendor:

Form 4: VAST Completion Report

Once completed, please submit to OAR Subject heading: VAST Completion Report

When your project is completed, you are required to fill in the following completion report and turn it in to theVAST grants manager with the Project Log and corresponding receipts. Please enter the final numbers for relevant indicators and respond to the narrative questions.

How did the project achieve the goals and objectives? Please state your results per objective.
Please describe any anecdotal evidence/stories from community members that attest to project success.
What worked well during implementation of the project?
What did not work well while implementing the project?
What were the major lessons learned during this project?
Did your project change from the original proposal? If so, how?
Based on your experience, what would you recommend for future projects?
Abstinence and Being Faithful
AB Indicator / # Men (25 & >) / # Youth Boys (15-24) / # Boys (<15) / # Women (25 & >) / # Youth Girls (15-24) / # Girls (<15) / Total
# Of people who will receive HIV prevention interventions primarily focused on abstinence and/or being faithful.
Other Prevention
# Of people who will be reached with individual and/or small group level HIV prevention interventions.
Other Prevention - Most At-Risk Populations
# Of MARPs who will receive individual and/or small group level HIV preventive interventions.
Care - One Care Service
Care - One Care Service / # Men (25 & >) / # Youth Boys (15-24) / # Boys (<15) / # Women (25 & >) / # Youth Girls (15-24) / # Girls (<15) / Total
# Of eligible adults and children who will receive a minimum of one care service.
Care- Food and/or other Nutritional Service
# Of eligible adults and children who will receive food and/or nutritional services.
Human Resources for Health (HRH)
HSS- Human Resources for Health (HRH) / # Men (25 & >) / # Youth Boys (15-24) / # Boys (<15) / # Women (25 & >) / # Youth Girls (15-24) / # Girls (<15) / Total
# Of health care workers who will successfully complete an in-service training program within the reporting period.
TOTAL:
Total Estimated Beneficiaries to be Reached / # Men (25 & >) / # Youth Boys (15-24) / # Boys (<15) / # Women (25 & >) / # Youth Girls (15-24) / # Girls (<15) / Total
# Of individuals and/or service providers who will be assisted or trained by this VAST project

Project Log:

Please keep track of your expenditures using this project log.

Volunteer Name: / COS Date:
VAST Project Title: / Community Organization Name:
Implementation Period:
Date / Invoice Receipt / Description / Funds Expended
(Local Currency) / Balance