Page 1 of 4
American Spaces Funds Request Template
All sections are required
Section 1 - General Information
•Institution
•City
•Project Title
•Name of Project Manager
•E-mail/Phone for contact
•Project Summary- Description of project in 100 words or less
Section 2 – Justification
Justification: An American Space is a robust platform to engage foreign publics, in person and virtually, on U.S. Mission
Brazil’s priority in strengthening Science and Technology and Social Inclusion objectives. In as great a detail as possible,
describe how requested funding ties to these priority. In this narrative, BNCs requesting funding for a special program
(ex.: a State Department Alumni provides leadership training to public school students) should provide details on how it
furthers public diplomacy goals and how the requested resources will support the program. The special program does
not have to be based on one of the five core American Space program themes, but it can be.
Section 3 - Objectives
This section should describe what the project is expected to achieve in terms of effects among intended audience.
Specifically, the section discusses the changes that are expected to occur among intended audience if project operations
are successful. Changes can include new and improved technical skills and knowledge, increased income-generating
capacities, and greater public awareness at the community. When describing your project objectives, make sure that
they are written the SMART way:
Page 2 of 4
Section 4 - Implementation of Standards
Indicate the number of programs conducted in FY15 for each of the 5 core programs:
English language learning:
EducationUSA advising:
Cultural programs:
Alumni programs:
Information about the United States:
Standards Assessment
(After filling out the Standards Matrix, complete this section)
Overall Level
Select the Space’s overall standards level. [Select one: Below Bronze, Bronze, Silver, or Gold]
Sub-Categories Level: Select the Space’s standards level for each sub-category of the American Spaces Standards listed
below.
English Language Learning: [Select one—Below Bronze, Bronze, Silver, Gold]
EducationUSA: [Select one—Below Bronze, Bronze, Silver, Gold]
Alumni Activities: [Select one—Below Bronze, Bronze, Silver, Gold]
Cultural Programs: [Select one—Below Bronze, Bronze, Silver, Gold]
Information about the U.S.: [Select one—Below Bronze, Bronze, Silver, Gold]
Staff: [Select one—Below Bronze, Bronze, Silver, Gold]
Tech Support: [Select one—Below Bronze, Bronze, Silver, Gold]
Embassy Oversight: [Select one—Below Bronze, Bronze, Silver, Gold]
Planning: [Select one—Below Bronze, Bronze, Silver, Gold]
Page 3 of 4
Reporting: [Select one—Below Bronze, Bronze, Silver, Gold]
Evaluation: [Select one—Below Bronze, Bronze, Silver, Gold]
Email: [Select one—Below Bronze, Bronze, Silver, Gold]
Marketing: [Select one—Below Bronze, Bronze, Silver, Gold]
Appearance - Branding: [Select one—Below Bronze, Bronze, Silver, Gold]
Appearance - Signage: [Select one—Below Bronze, Bronze, Silver, Gold]
Appearance - Décor: [Select one—Below Bronze, Bronze, Silver, Gold]
Physical Space: [Select one—Below Bronze, Bronze, Silver, Gold]
Furnishings: [Select one—Below Bronze, Bronze, Silver, Gold]
Accessibility: [Select one—Below Bronze, Bronze, Silver, Gold]
Equipment: [Select one—Below Bronze, Bronze, Silver, Gold]
Section 5 – Location
Location: Describe the layout of the physical space, including approximate size (For example: 1 or 2 floors, each floor is
100 square meters or 1000 square feet) and the location in relation to public transport and neighboring communities or
businesses. [Free Text]
Section 6 – Management and Staffing
Management and Staffing: How will the facility be managed and staffed? What are the days and hours of operation?
[Free Text]
Section 7 – Funding
Tracking of award funds: Briefly describe how the institution keeps track of awards funds. Description should include
institution’s standard account procedures and any relevant information regarding its financial situation.
Funding History: Provide a brief narrative summarizing total FY15 support funds received and how they were spent.
Please explain any material deviations from the approved budget that was funded. [Free Text]
Total FY16 Support Funds Requested : Enter the total amount you are requesting – this number should be the same as
the total amount you entered on your budget template. [Total -- USD currency, no decimal places]
Budget Line Items: The Budget Template is divided into subcategories. Please enter your subtotal for each of these
budget subcategories, next to its corresponding subcategory name listed below:







FURNISHINGS [Subtotal -- USD currency, no decimal places]
BUILDING EXPENSES & RENOVATIONS [Subtotal -- USD currency, no decimal places]
PROGRAMMING [Subtotal -- USD currency, no decimal places]
MEDIA [Subtotal -- USD currency, no decimal places]
TECHNOLOGY [Subtotal -- USD currency, no decimal places]
FUNDING FROM OTHER SOURCES [Subtotal -- USD currency, no decimal places]
COST SHARING BY PARTNER** – [Subtotal – USD currency, no decimal places]
Page 4 of 4
** Required for partner Spaces requesting funding in excess of $25,000
Internet Speed: Are you requesting funds for Internet improvements—whether service or equipment?* [yes/no]
If so, please calculate the Space’s upload and download speeds using this test link (http://www.speedtest.net/) and
enter your results below:
 Upload speed—include number and whether kbps or mbps [Free text]
 Download speed—include number and whether kbps or mbps [Free text]
Additional Comments: Use this section to describe any special circumstances impacting your Space’s operations or
anything else we should know about the project. [Free text]
Section 8 – Project Monitoring and Evaluation
This section should discuss proposed mechanisms and procedures for monitoring of project operations to ensure that
activities occur as planned, that they remain directed towards stated objectives, and that appropriate corrective action
is taken if required.
Specifically, the discussion must indicate who will be responsible for preparing periodic project progress and final
technical reports and for the accounting of expenditures. This section should also identify the party who will be
responsible for this task.
Section 9 - Risk Assessment
This section should identify any possible risk that would keep the BNC from concluding the project as described and it
should also include a plan of action in case these risks become a reality.
Revised 9/28/2015 - IRC Brasilia