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(Please
fill all the columns in the application form)
A. Organizational Profile
1. Name of the Organization:
2. Address and contact details:
����������� ����������� Contact person:
Phone:
(O)������ ����������� ����������� (R)������ ����������� ����������� Fax:
������������ ������������ E-mail:
����������������������� ������������ Website:���������
3. Registration details:
�� (Please enclose relevant photocopies)
4. Organization Profile
including Objectives and Major Activities:
����� (Not more than 300 words)
�5. ������ a) Organizational Structure
����������� b)
Current Annual Budget
c) Detials of
Current staff and Qualifications: indicate total number and number of�
� ��professional, administrative and support staff etc. In each
category, indicate the
���� number of men and women.
d) Proven in-house experience � evidence ( in the
science and technological
��� component
of the project ) that the applicant can successfully implement the project.
������������
6. Project Title:
7. Project Budget :
8. Project Location:
������������ Region/State:��� ������������ Nearest City:�������������� ������������
������������
9. Duration:
10. Person responsible
for the Project:
11 ( a) Goal of the project�
����� (b) Purpose/Objectives of the project:
12(a)
Project Outputs
��� (b) Major Activities (required to
achieve the Project Purpose)
��� ( c) Time Schedule of
activities to be clearly explained through Activity Charts
��� (d)�
Key project Risks
13. Justification
for the project (Why do you want to do this project) :
14. Project Strategy
to achieve the project purpose:
15. Project Beneficiaries:
16. Role of
Communities in the project (both in taking decisions, fund
contributions(actual/kind), Ownershiip, Planning, execution and implementation
� not to exceed 150 words.)
17.Global Environment Impact of the project (Explain how this project
helps in
����� conservation of environment in 150
words.)
18. Replicability of the project .
19. Sustainability
of the project activities (Mechanisms and How)
20. Scientific and
Technical Content (not more than 250 words)
�Scientific and Technical
inputs required for the project and mechanisms for the same.
21. Relationship to SGP Thematic
Area/Mandate
22.� Project Impact Indicators (to monitor
and evaluate progress in activities):
23. Networks/ Links with
Government / Line departments / scientific institutions/ academic
���� Institutions, etc.
24.What impacts it will
create in terms of Policy/ Advocacy/ Sustainability/ and
����� Replicability
in long term.
25. Media Coverage
(Needs to be encouraged and covered during the life of the project)
26. Other development/
environment agencies/ projects using the SGP Approach
27. Does the proposal
require any specific permission? Which are these? Have they been
28.Racial Discrimination
Please ensure and state that benefits of the projects will be avaiable to all without any
racial/religous discrimination.
����� Obtained from necessary
Central/State/District level governments / Departments / Forest/Institutions.
(If yes, please attach relevant documents)
27. Estimated total
project cost:
28. Suggested format for
Budget Break down (Please add heads/subheads/columns as required)
|
Sr. No |
Components |
Amount requested from
SGP (Rs.) |
Co-financer (Rs) |
NGO�s contribution (Rs) |
Total (Rs.) |
% of the total budget |
|
|
Years |
1����� 2����
3 |
1��� 2����
3 |
1��� 2����
3 |
1��� 2��
3� |
1� 2�
3 |
|
A. |
Project Activities (Please specify and give detailed activity wise
break up with unit costs) |
|
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B. |
Staff Costs |
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C. |
Training,
workshops,� Exposure visits &
Seminars |
|
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D. |
Travel Costs |
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E. |
Consultants/ Resource
persons |
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F. |
Communications and
Admn. |
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G. |
Monitoring &
Evaluation |
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H. |
Documentation &
Reporting |
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I. |
Any other (please
specify) |
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J. |
Contingency ( not more
than 2- 5 % of the total project cost) |
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����� �
Note : For contingencies costs, approval needs to be taken from the
National Coordinator. Also certify that the SGP component is not being funded
through any other source of funding agency.
As explained in point 12 (c)
|
Sl. No |
Activities |
Month(s)� / Year(s) |
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|
Jan |
Feb |
Mar |
Apr |
May |
June |
July |
Aug |
Sep |
Oct |
Nov |
Dec |
����������������������� ����������������� ����������������� �����
����������������������� ����������������������� ����������������������� ����������� ����������� Signature of the authorized person
����������� ����������� ����������� ����������� ����������� ����������� ����������� With
designation and stamp
Annexures:
1.
Annual Report
2.
List of key professionals
3.
Registration certificates
4.
Audited financial reports of 3 years
5.
Any other attachments (if required)