Concept Idea Application Form
Social Enterprises to Promote Social Inclusion and Employment of
Disadvantaged Groups
Completed applications must be sent by email to iompristina@iom.int with subject heading
“CONCEPT IDEA”
Deadline for submission of applications 29th January 2016, 15:00 hr
APPLICANT INFORMATION
Name of Applying Entity
Legal Status, Type of Organization
Address
Contact Person
Title of Contact Person
Contact Details (email, telephone)
Website
This project is funded by the U.S Department of State Bureau of Population, Refugees, and Migration,
and implemented by the International Organization for Migration (IOM), Mission in Kosovo.
1. PROJECT IDEA
1 page maximum, Ariel font size 10pt
a. Summarize your project idea and overall goal. (Maximum 150 words)
b. Where will the project take place?
c. What product or service will your initiative offer?
d. Who is your primary target group? (ethnic minorities, persons with disabilities, women, youth, other
disadvantaged or vulnerable groups)
e. How will your project contribute to the integration of your target group with the community?
1
This project is funded by the U.S Department of State Bureau of Population, Refugees, and Migration,
and implemented by the International Organization for Migration (IOM), Mission in Kosovo.
2. TRIPLE BOTTOM LINE
1 page maximum, Ariel font size 10pt
a. What is the social problem you intend to address? What is your social mission? (“Social bottom line”)
b. How will your enterprise sustain itself and grow? (“Economic bottom line”)
c. How will your enterprise contribute to a healthier, more liveable environment in your
community? (“Environmental bottom line”)
2
This project is funded by the U.S Department of State Bureau of Population, Refugees, and Migration,
and implemented by the International Organization for Migration (IOM), Mission in Kosovo.
3. WHY A SOCIAL ENTERPRISE?
1 page maximum, Ariel font size 10pt
a. Why is your social enterprise necessary? Have you conducted market research or tested the idea
previously?
b. How will you draw upon business techniques to find a solution to the social problem your project aims to
address?
c. What is your connection to the community?
d. Why is your organization the most suitable or experienced to implement this idea?
3
This project is funded by the U.S Department of State Bureau of Population, Refugees, and Migration,
and implemented by the International Organization for Migration (IOM), Mission in Kosovo.
4. BUDGET
Equipment
€
Materials
€
Services
€
Consumables
€
Other (please describe*)
€
Total Amount of Grant Requested (A):
€
List applicant’s own and external
financial contributions.
Applicant contributions (please
describe*)
€
(Minimum 15% of grant
requested, see guidelines)
External contributions (please describe*)
€
Total Amount of Co-financing (B)
€
Breakdown of expenses the
grant will be used for
(See guidelines for eligible
costs)
TOTAL AMOUNT OF PROJECT (A+B)
*
€
Add additional rows, if necessary.
4
This project is funded by the U.S Department of State Bureau of Population, Refugees, and Migration,
and implemented by the International Organization for Migration (IOM), Mission in Kosovo.
DECLARATION BY THE APPLICANT
I, being the authorized signatory of the applicant and representing any partners in the proposed action,
hereby confirm that I have completed this application myself and that all information within is accurate
and correct to the best of my knowledge.
I also declare that if any information in this application form is provided false, my application may be
rejected at any point in time.
I the undersigned declare that the data contained in this application have been disclosed by my free will
in the meaning of the Law No.03/L – 172 ON THE PROTECTION OF PERSONAL DATA, and hereby
grant my explicit consent that the filled application form will be used by International Organization for
Migration (IOM) in fulfilment of their activities.
Name of the Applicant
Signature
Date of Submission
5
This project is funded by the U.S Department of State Bureau of Population, Refugees, and Migration,
and implemented by the International Organization for Migration (IOM), Mission in Kosovo.
Concept Idea Application Form Evaluation Grid
Social Enterprises to Promote Social Inclusion and Employment of Disadvantaged Groups
1. PROJECT IDEA
1.1. How relevant is the proposal to the objectives
and priorities of the Social Enterprise Grant
Scheme (clear project idea, clearly identified
target group, clear products or services, clear idea
for the integration of target group)?
10 points maximum (5*2)
/ 10
2. TRIPLE BOTTOM LINE
/ 15
1.2 How clearly defined and relevant are the
social, economic, and environmental goals?
15 points maximum (5*3)
3. WHY A SOCIAL ENTERPRISE?
1.3 Have the needs and feasibility of the Social
Enterprise been clearly defined and has the
applicant demonstrated its suitability to implement
it in the community?
/ 15
15 points maximum (5*3)
4. BUDGET
10 points maximum (5*2)
/ 10
6
This project is funded by the U.S Department of State Bureau of Population, Refugees, and Migration,
and implemented by the International Organization for Migration (IOM), Mission in Kosovo.
1.4 Are the estimated costs accurately presented
and are they feasible to implement the stated
objective. Has the applicant listed viable cofinancing or external financing means?
Maximum Total Score
/ 50
5 = excellent, 4 = good, 3 = average, 2 = below average, 1 = poor
Concept notes with a score lower than 30 will be rejected. Concept notes that reach the
above threshold will be ranked by score. The highest scoring applications will be shortlisted and invited to submit a full application.
7
This project is funded by the U.S Department of State Bureau of Population, Refugees, and Migration,
and implemented by the International Organization for Migration (IOM), Mission in Kosovo.