Micah Network Emergency Response Proposal Template
When preparing a proposal using this template, you will need to refer to the Micah Network Emergency Response
Proposal Guidelines (October 2006 version) as it requires additional details to be provided. Alongside each
heading in the template, you will see the clause reference for the corresponding section of the Guidelines.
Section A.
Basic Information (maximum one page)
—Emergency Response Proposal Guidelines Part 2A
The title of the programme /
SP reference number (if any)
The name of the Implementing
Partner requesting funding
Description of the programme
(maximum 100 words)
Implementing Partner contact
person details:
Name
Role (Job title)
Address
Tel
Fax
E-mail
Website
The name and role of the person
approving the application for the
Implementing Partner. This person
must be duly authorised.
The planned start date and
duration of the programme.
Micah Network Emergency Response Proposal Template (Version date: Oct 2006, Tearfund May 2012)
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The location of the programme area
List the international standards and
quality commitments which the
Implementing Partner has adopted
to guide its practice in relief
programmes.
The name(s) of any other
implementing partner(s) who will be
involved in the programme with the
Implementing Partner.
Overall budget of the programme.
The amount that the Implementing
Partner is requesting from the
Supporting Partner with details of
other contributions as set out in the
table below.
Activity Year
Period 1
Period 2
Period 3
Supporting Partner
Other supporting partners
Local and other income
Total
The date that the proposal was
written (or date of latest revision)
Section B
Information about the Disaster (maximum one page)—Emergency Response Proposal Guidelines Part 2B
Section C
Emergency Response Design (maximum one page)
—Emergency Response Proposal Guidelines Part 2C
Section D
Programme Logframe (maximum one page)
—Emergency Response Proposal Guidelines Part 2D/3
Objectives
Indicators
Goal
Purpose
Outputs
Activities
Micah Network Emergency Response Proposal Template (Version date: Oct 2006, Tearfund May 2012)
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Section E
Programme Approach and Justification (maximum one page)
—Emergency Response Proposal Guidelines Part 2E
Section F
Programme Management (maximum one page)
—Emergency Response Proposal Guidelines Part 2F
Section G
Risk Assessment and Management (maximum one page)
—Emergency Response Proposal Guidelines Part 2G
Section H
Budget (maximum two pages)
—Emergency Response Proposal Guidelines Part 4
Expenditure
Items
Unit
costs
No of
units
Total
Amount from
Supporting
Partner
Notes and
explanations
Activity and material costs
(Relief inputs)
Personnel and related costs
Transport and logistics costs
Capital costs
Evaluation costs
Field support costs —
administration and
communications
Head Office support costs
(limits may be applied by the
Supporting Partner)
Other costs
Total Expenditure
Income
Name other
donors/describe
sources of income
Amount
Requested/Expected
Amount Committed
Supporting Partner
supporting partner 2
supporting partner 3
supporting partner 4
Other donors
In-kind donations
Local contributions
Other (please specify)
Total Income
For any variance that exceeds 10% of the budget and US $ 500 the reasons for the over-or under-spend must
Micah Network Emergency Response Proposal Template (Version date: Oct 2006, Tearfund May 2012)
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be explained.
Section I
Bank details (maximum one half page)
—Emergency Response Proposal Guidelines Part 5
Detail
Account Name
Account Number
Bank Swift Code/BIC number (if known)
Currency of Bank Account
Name of Bank
Address of Bank
Address of Organisation
E-mail Address of Organisation
Micah Network Emergency Response Proposal Template (Version date: Oct 2006, Tearfund May 2012)
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Annex: Differing Requirements
Section K
The Local Church (maximum one page)
—Emergency Response Proposal Guidelines Annexure 2a
Local Church Mobilisation and Christian Witness:
Church Mobilisation Numbers:
Year
1
2
3
Total
Please estimate the number of new churches to be mobilised during
each year of the project and hence the total for the life of the project.
Section L
Number
Method of counting beneficiaries
—Emergency Response Proposal Guidelines Annexure 2b
Method:
Beneficiary Numbers:
Please estimate the total number of
beneficiaries being served during each
year of the project. (Column A)
Of those in A, how many are new to
the project each year? (Column B)
Of those in B, how many have already
been reported (since 2007) in other
Tearfund supported projects? (Column
C)
Hence determine for each year the
number of new Tearfund beneficiaries.
(Column D = column B – column C)
Project
Year
Total
being
served
each year
A
Number
new to
project
each year
B
Previously
reported
elsewhere
New to
Tearfund
each year
C
D = B-C
1
2
3
Total
Of the total beneficiaries for all years of the project Female and over 18 years
(total of column B), what percentage are:
Female and under 18 years
Male and over 18 years
Male and under 18 years
Total
%
%
%
%
100%
Micah Network Emergency Response Proposal Template (Version date: Oct 2006, Tearfund May 2012)
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Beneficiaries by Sector:
Please state the number of beneficiaries receiving
assistance during the life of the project in each of
the sectors in the table. It is recognised that the
same person may be receiving benefits in more
than one area so could be recorded more than
once, and that the totals cannot be aggregated.
Local level advocacy will often be connected with
support in one of the other sectors.
HIV
Health and Nutrition
Water and Sanitation
Basic Education and Literacy
Vulnerable children
Livelihoods and Shelter
Environmental Sustainability and
Disaster Risk Reduction
Local level Advocacy
(Others – please state)
Section M
Quality Standards Verification
This form requires partners to briefly outline how the quality standards will be reflected in the project
implementation.
The questions in normal font refer to core quality standards and all must be answered.
For emergency projects over £100,000, the CR/Partner should select those questions in italics that are a
priority to the project and comment on how the project will apply them. Where an emergency project is for
£100,000 or less the questions in italics are optional.
brief responses only:
1. Values
How are staff made familiar with the organisation's values, the types of unacceptable
conduct (eg . exploitation and abuse of children and vulnerable adults, fraud, bribery)
and their disciplinary procedures?
2. Impartiality &
Targeting
How are beneficiaries selected? Describe how this is based on need and on the most
vulnerable people being reached.
3. Accountability
How are community groups participating in the planning of the project? Are staff
openly sharing information about the project's aims and ensuring people can give
feedback about its delivery?
4. Sustainability
How is the project being designed to be sustainable or replicable?
5. Advocacy
How is the project being designed to address local or national policy issues relevant to
the project objectives?
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6. Children
How is the project being designed to prevent an increase in the vulnerability of
children?
How is the project being designed to support child development and to protect
children from harm?
7. Gender
How is the project being designed to prevent an increase in the vulnerability of
women?
How is the project being designed to promote inclusiveness of both men and women,
and enhancing the safety of women and girls?
8. HIV
How is the project being designed to prevent an increase in the vulnerability of people
to HIV?
How is the project being designed to reduce the likelihood of people becoming more
vulnerable to HIV?
9. Environment
How will the project ensure that it is not contributing to environmental degradation?
How is the project being designed to reduce environmental damage and to increase
positive environmental outcomes?
10. Disaster Risk
How is the project being designed to build up community capacity and address longterm vulnerability to disasters?
11. Conflict
How is the project being designed to avoid heightening tension or making people
more vulnerable to physical harm?
How is the project being designed to promote peace and reconciliation?
12. Technical
Standards
How is the project design ensuring that its outputs will be of a good technical
standard?
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