Conservation International as Facilitator Administrator
Sustainable Landscape Partnerships (SLP)
Grant Application Form
Cover Sheet
Reference: (Request for Proposals Number)
The Opening and Closing deadline dates for this call for applications:
Opening Date:
Closing Date:
Activity Title for this Call for
Applications:
Name of Applicant:
Project Title:
Project Location:
Total Project Budget
(A=B+C+D)
(specify currency)
Proposed Project Start Date:
Proposed Project Duration:
Applicant Information:
Organization Legal
Name:
Lead Contact Name and
Position:
Lead Contact Email:
Mandailing Natal – North Sumatera Province, Indonesia.
Amount requested
from Conservation
International (B)
Amount from
Other Sources (C)
Value of In-kind
Contributions (D)
(if applicable)
(if applicable)
Lead Contact Mobile
Phone Number:
Organization Mailing
Address:
Organization Physical
Address: (if different from
mailing address)
Telephone Number:
Country code + city code +
number
Fax Number: Country
code + city code + number
DUNS Number:
(Mandatory)
(if you don’t have a DUNS number you can register for one at the
following website:
http://fedgov.dnb.com/webform/displayHomePage.do )
Year Organization
Established:
Total Permanent Staff:
Date of Submission:
Signature of Executive
Director or other
authorizing official:
Any change in address, phone number, fax number and in particular e-mail, must be notified in writing to
Conservation International. Conservation International will not be held responsible in the event it cannot
contact an applicant.
FULL APPLICATION FORM
LOW EMISSIONS ENTERPRISE (LEE) SUPPORT
INSTRUCTION TO APPLICANTS:
 Proposals should be typed, no hand written proposals will be accepted.
 Proposals should be no longer than 10 pages in length and must be submitted using the format
below.
P ART I: DESCRIPTION
1.1 Project Title:
Provide a title for your project.
1.2 Location:
Provide a map and details of the location of the proposed project in Mandailing Natal if known. If not yet
known, describe how the areas for project activities will be identified upon receiving funding.
1.3 Type of support requested:
1.3.1 Check one or more of the below
Grant financing
Offtake agreement
Other (loan, guarantee, etc)
1.3.2 Describe what the requested funding will be used for. How will SLP funding prove catalytic to the
LEE?
1.4 Executive Summary:
Provide an executive summary of the project. Include an overview of the objectives of the project,
proposed activities, targeted beneficiaries, and the expected results.
1.5 History and Mission:
Briefly describe your organization’s history and mission including experience relevant to the proposed
project, including relevant LEE / business development experience in Indonesia.
1.6 Objectives:
Describe the objectives of the project.
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1.7 Project Rationale:
1.7.1 What identified “need” or demand does the LEE seek to fulfil (conservation and/or socio-economic
issues and key threats and/or opportunities)?
1.7.2 What SLP strategic priorities, as defined in the Call for Proposals announcement, does the project
meet? For background information, the Sustainable Investment Action Plan report can be found at
http://www.conservation.org/about/centers_programs/slp/Documents/SIAP_synthesis_FINAL.pdf.
1.8 Low Emissions Business Models:
1.8.1 Please describe the business model underpinning the LEE.
1.8.2 Is the LEE an “alternative” approach to an existing high/emissions activity? If so, what is the
potential emissions reductions of the LEE?
1.9 Project Approach:
1.9.1 Describe the proposed strategy and project activities that will be implemented to accomplish the
project objectives, including anything about the approach that should be considered “innovative”.
1.9.2 Outline the approach and methods, including any pre-project scoping studies, you will take to
ensure your proposed LEE will be appropriate according to the local context and targeted beneficiaries.
1.9.3 Describe how the project will be managed and identify any potential risks or challenges you face in
implementing the LEE. Include information on the existence of partnerships or alliances with whom you
intent to work, and their respective roles.
1.10 Project Beneficiaries and Stakeholders:
1.10.1 Provide an overview of the targeted beneficiaries of your project and other key stakeholders who
will be involved, as well as an outline of the process that will be undertaken to identify these groups
during the project design stage. Strategies to target the involvement of vulnerable or poorer groups,
including women should be outlined where relevant.
1.10.2 Will the LEE create jobs (temporary or permanent) for local people? If so, roughly how many and
what types?
1.11 Project Schedule:
Include an estimated timeline for project development and implementation activities during the grant
period. The SLP will prioritize projects with short-start up periods.
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1.12 Link to SLP Objectives:
Clearly articulate how this project fulfils the SLP’s program objectives. Specifically:
 To demonstrate low emissions development models that contribute to improved livelihoods and
the preservation of natural capital including biodiversity;
 To increase private sector engagement and catalyse investment into low emissions
development in target landscapes;
 To increase awareness and support among key stakeholders for Sustainable Landscapes.
1.13 Project Results:
Provide an overview of the anticipated project results.
1.13.1 What results are you committed to achieving during the grant period?
1.13.2 What will be the key milestones and demonstration of progress in the first 12 months of
implementation?
1.13.3 What evidence will prove your success? Your answer should make reference to how the project
will demonstrate success in addressing the specific conservation and/or socio-economic issues identified
in the Call for Proposals.
1.14 Sustainability:
The SLP will only fund low emissions business models that can demonstrate their long-term sustainability.
Please describe how the benefits and work of the project are expected to continue after the end of the
grant period.
1.14.1 Financial sustainability. How and when will the LEE achieve financial self-sustainability?
1.14.2 Does the business model depend on carbon finance for part of its revenue? If yes, please
elaborate on any relevant methodologies to be used and potential marketing channels.
1.14.3 Institutional sustainability. Is local ‘ownership’ envisaged? What is the plan for ensuring the LEE
has a long-term presence in the region?
1.14.4 Policy integration. Will the project work to ensure that lessons learnt and results are integrated
into local and/or national policy processes and debates?
1.15 Replicability:
If applicable, please describe how the project could be replicated, and at what scale. If the proposed LEE
is itself a replication of an existing project, please describe the existing project and the rationale for
expansion in this region.
1.16 Endorsement from other organizations
Please provide two Letters of Endorsement from other recognized national or international agencies or
authorities attesting that your organization has the necessary experience and expertise to carry out the
project.
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PART II: BUDGET
1. Please complete the budget spreadsheet attached.
2. Please provide a budget narrative to accompany the proposed budget spreadsheet. The purpose
of the budget narrative is to supplement the information in the budget spreadsheet by justifying
how the budget cost elements are necessary to implement project objectives and accomplish the
results. The narrative should include all assumptions, qualifications, and unit costs necessary to
clearly convey the cost of the project.
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