Concept Paper Format for the USAID’s Small Grants Program Small Grants and Ambassador’s Fund Program (SGAFP) Small Grants and Ambassador’s Fund Programme Project Office: 10, Street No. 30, F-7/1, Islamabad T: +92 51 2656433-35; Fax. No. +92 51 2656436 Email: info@sgafp.org.pk Website: www.sgafp.org.pk USAID Disclaimer: This application guideline and form for the Small Grants Program is made possible with support from the American people delivered through the United States Agency for International Development (USAID). The contents are the sole responsibility of National Rural Support Programme (NRSP) and do not necessarily reflect the views of USAID or the United States Government. USAID’s Small Grants and Ambassador’s Fund Program CONCEPT PAPER FORMAT for SMALL GRANTS PROGRAM Note: 1. The total length of the concept paper must not exceed 6 pages, excluding any annexure. 2. All concept papers must be submitted directly to the SGAFP through email applications@sgafp.org.pk or hard copy to the central program office in Islamabad. Any expenditure associated with the preparation and submission of the application will be the responsibility of the applicant. Concept Paper submission date: -------------------------------------------------------------------------------------- Section A: The Applicant Organization a. b. c. d. Name of the organization: Date of establishment: Date of registration: Type (CBO/NGO/ Private Sector / others – specify). Specify the relevant law under which the entity is registered. e. f. g. h. i. j. k. l. Name of head of the organization: Postal address: Office phone numbers: Fax: Email: Website: Key contact person (name & designation): Cell number of the key contact person: Section B: The Proposed Project 1. Grant Activity Title: -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2. Duration (months): -----------------------------3. Sector (Please check one) Energy Education Health – mother & child healthcare, hygiene Economic Growth – (including Agriculture) Governance Gender Stability in Khyber Pakhtunkhwa & FATA Note: 1. SGAFP strongly encourages the applicants to focus on one sector and related activities instead of proposing activities in multiple sectors. 2. Gender and Governance will also be crosscutting for all sectors. Concept Paper Format for the USAID’s Small Grants Program 2 USAID’s Small Grants and Ambassador’s Fund Program 4. Project Location: Please tick the relevant Province/Region and provide details Province/Region District(s) Tehsil(s) Union Council(s) AJK Balochistan FATA Gilgit-Baltistan Islamabad Capital Territory (ICT ) Khyber Pakhtunkhwa Punjab Sindh 5. Background and Need for the Project Briefly describe the situation/circumstances which have led to the need to develop the proposed project. Support your arguments with primary and/or secondary research and statistics. Please give complete and appropriate references where required. Please note that USAID encourages demand oriented projects. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------6. Measurable Project Objectives and Key Activities Please briefly mention all project objectives with key activities to achieve these objectives. Project Objectives Key Activities 1) 2) 3) 7. Project Implementation Methodology Provide a well-articulated implementation methodology reflecting systematic flow of activities and focusing on community involvement in the design and implementation of proposed project. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------8. Proposed Project Beneficiaries Please provide details on (a) beneficiary’s type & numbers (in terms of households, persons, institutions etc.): and (b) methodology for beneficiary selection. Kindly highlight as to how will the organization ensure inclusion of disadvantaged groups and gender equity in the later. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Concept Paper Format for the USAID’s Small Grants Program 3 USAID’s Small Grants and Ambassador’s Fund Program 9. Indicative cost of the Project – Pak. Rupees Amount Category US $ * PKR. % of Total Cost a. Organizational contribution (if any) b. Third party contribution (if any) c. Grant funding requested from SGAFP Total estimated cost * 1 US$ = PKR: ---------------11. Itemized Budget: Please attach a brief breakdown of the cost or itemized budget in Pak rupees (PKR). This is an essential part of the concept paper. The itemized budget can be presented on the following format: Activity Unit Type Unit No. Unit Cost Total Estimated Cost Funds requested from USAID Applicant Cost Share * A. Program Cost ** B. Administrative Cost *** Total * The applicant cost share under Small Grants Program is not mandatory. However SGAFP strongly encourages applicant’s cost share in cash or in kind. ** Program Cost includes direct project related costs such as: staff working full time on project implementation; rent of the office directly overseeing project activities; material, equipment, stationary, utilities, vehicle rental and POL to be used only for project implementation, and USAID’s branding & marking related cost (plaques/signboards/banners etc.) *** Administrative Cost includes expenses that indirectly support project implementation such as: support staff cost (finance persons, M&E, management etc.); rent of organization’s other office(s); project’s audit; etc. Note: In event of any third party contribution, please add another column. The cost breakdown listed therein should be in accordance with the guidelines given above. 12. Details of previously completed and ongoing projects (giving the latest project at the top) for the last three years S. Project Name Funding Project Project Total Major Achievements No. Agency Duration Location(s) Budget (From – (PKR) To) Concept Paper Format for the USAID’s Small Grants Program 4 USAID’s Small Grants and Ambassador’s Fund Program Section C: Declaration from the Applicant S. No. Statements Yes 1. Whether organization will need necessary permissions such as: No Objection Certificate (NOC)/Letter of Commitments (LoC)/Memorandum of Understanding (MOU) from government and/or other stakeholders to implement the project? If Yes, please provide a list. These will be required upon the approval of concept and at the time of submitting full application. 2. The organization will be able to implement the proposed project without creating any local conflict 3. The organization will fully comply with USAID’s branding & marking requirements as explained at SGAFP’s website 4. The organization confirms that the project location is safe and subject to the approval of project, SGAFP’s staff can undertake monitoring visits safely. Submitted by: Signature of Authorized Person Name Date: Designation: Concept Paper Format for the USAID’s Small Grants Program 5 No.