Johns Hopkins International Injury Research Unit Saving of Lives from Drowning – Grants Initiative FORM A – Project Proposal ORGANIZATION Organization’s legal name University/ Hospital / Research Institute/ My organization is Nongovernmental/Governmental NonGovernmental/Other (please specify) Registered Address Telephone Number + Fax Number + APPLICANT CONTACT INFORMATION Position/Title (Dr / Ms /Miss / Mrs/ Mr etc) Contact person First name Family name Email Secondary email PARTNERING ORGANIZATION CONTACT INFORMATION (if applicable) Position/Title (Dr / Ms /Miss / Mrs/ Mr etc) Contact person First name Family name Email Secondary email PARTNER CONTACT INFORMATION Position/Title (Dr / Ms /Miss / Mrs/ Mr etc) Contact person First name Family name Email Secondary email PROJECT Project title (20 words or less) Total amount requested in USD Duration of project (in months) Up to 12 months Proposed start date of project Project outreach: population (number of people) that will be directly affected by your project Notes: Please respect the maximum word count indicated for each section. Text boxes are indicative only. Font size should be kept to 11pt. To enlarge the box, simply keep typing. To reduce it, delete line spaces. PART A: PROJECT SUMMARY Provide a concise summary of your proposal (250 words maximum). Should summarize all central elements of the proposal. Proposal form – Page 2 PART B: BACKGROUND AND JUSTIFICATION Describe briefly the context in which the project will take place. Outline the main drowning problem that your project addresses. Describe the main actors – target group, implementing partners etc. in this project. Include any existing or planned complementary activity by organizations in your country (government, NGOs, international bodies etc). Indicate how cooperation and coordination will be ensured. (1000 words max.) PART C: PROJECT GOALS AND OBJECTIVES What is the overall purpose of the project. What are the measurable objectives. Each specific objective should be clearly stated, measurable and attainable during the proposed project timeline. (250 words max.) Proposal form – Page 3 PART D: EXPECTED RESULTS OF PROJECT Expected results should directly correspond to specific objectives and project activities. They should be concrete, practical and achievable. (250 words max.) PART D: TARGET GROUPS Describe specific target groups of your project, relevant stakeholders to be addressed and potential allies. Also describe how you plan to mobilize/inform/engage the broader community/citizens Proposal form – Page 4 PART E: DESCRIPTION OF ACTIVITIES i) Describe the proposed activities and how they help achieve the project goal and objectives. If your organization will implement this project in partnership with another organization or association, identify the role of the prospective partner in implementing this activity. Include the desired timetable for the activities and a brief discussion of how activities will be sustainable after the funding period ends. Include a desired timetable for the project activities. (1500 words max.) ii) Monitoring and Evaluation (800 words max) Explain how you will monitor the effectiveness of your strategies and activities in order to check on progress and make any necessary mid-course changes. Include the monitoring and evaluation activities in your desired timetable. Proposal form – Page 5 PART F: PAST EXPERIENCE OR PERFORMANCE A description of applicant’s previous work and experience in implementing similar activities. (500 words max.) PART F: SIGNIFICANCE & IMPACT What is the major policy or operational impact of your project? How will it change the world of drowning prevention/control? (250 words max.) ADDITIONAL DOCUMENTS: In addition to this proposal form, please submit the following documents: 1) Budget (please refer to template which can be downloaded from the IIRU website: http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-internationalinjury-research-unit/research/Bangladesh_drowning/ 2) CVs of key personnel 3) Supporting letters from the head of the institution and collaborating partners (if applicable) Proposal form – Page 6 While the following documents are not required to be submitted along with the application form, all applicants must have them ready at the time of submitting the proposal: International Bank Wire Information Letter of introduction from the Bank Copy of the Institution’s registration certificate Most recent financial report Financial and administrative management and procurement manual Proposal form – Page 7