Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
SRHR programme: Bangladesh - reopened
Application form
Please consult sections 3 (Guidelines) and 6 (Instructions) of the call for proposals for information and
instructions concerning the application form
Registration
1.
Title
2.
Project
a)
Focus:
Tick box
Geographical focus
Bangladesh
b)
Duration (18 or 24 months)
Months
c)
Home country of consortium member organisations
Country
Organisation
Main applicant
Co-applicant
Co-applicant
Co-applicant
d)
Main field(s) of research
Please fill out one or more research fields and code from the NWO research field list (list these in
order of relevance.)
Code
Field of research
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Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
3.
Composition of the consortium
a)
Consortium members
Main applicant* (=coordinator)
Family name:
Co-applicant* (obligatory)
Family name:
First name(s):
First name(s):
Title(s):
Title(s):
Scientific discipline
Scientific discipline
Male/Female (M/F):
Male/Female (M/F):
Expertise(s):
Expertise(s):
E-mail:
E-mail:
Organisation’s name:
Organisation’s name:
Type of organisation**:
Type of organisation**:
Address:
Address:
Tel.:
Tel.:
Co-applicant of a practitioner organisation in
the focus country (recommended)
Family name:
Family name:
First name(s):
First name(s):
Title(s):
Title(s):
Scientific discipline
Scientific discipline
Male/Female (M/F):
Male/Female (M/F):
Expertise(s):
Expertise(s):
E-mail:
E-mail:
Organisation’s name:
Organisation’s name:
Type of organisation**:
Type of organisation**:
Address:
Address:
Tel.:
Tel.:
Co-applicant (if applicable)
* Please note: Either the main applicant or the co-applicant should be from a research organisation in Bangladesh.
The other research organisation can be from any country worldwide.
** Please specify: A = Research organisation or B = Practitioners organisation; and 1 = public, 2 = private nonprofit or 3 = private for-profit. For each organisation the specification is expressed as a combination of a character
A or B plus a digit 1 or 2 or 3.
*** Involvement of a practitioner organisation from the focus country as a 3rd co-applicant in the consortium is
recommended.
b)
Project staff
Name
Name of organisation
Type of
organisation*
2
Time
involvement
Role in the project
(months and
fte)
Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
Research proposal
4.
Consortium and track record
a.
Consortium: roles and added value
Word count:
(Max. 500 words, please add word count)
5.
b.
Recent publications
(Max. 5 recent publications per member, only for consortium members presented under 3a)
c.
CVs of consortium members
(Max. 1 page per CV, only of consortium members as presented under 3a, please include as an
Annex)
Summary of the project proposal
Word count:
(Max. 250 words, please add word count)
6.
Description of the project
Word count:
(Max. 2500 words, please add word count. Literature references can be added as an Annex, max. 1
page A4)
a) Background and rationale
b) Objectives
c)
Research questions and methods
d) Research activities
e) Relevance for development
7.
Knowledge sharing and capacity strengthening activities
(Max. 800 words, please add word count)
a) Knowledge sharing
b) Capacity strengthening
8.
Research impact pathway
a) Theory of change
(Narrative, max. 400 words, please add word count)
b) Diagram research impact pathway and indicators
(Complete the diagram on next page, max. 1 page)
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Word count:
Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
8b (continued) Diagram research impact pathway and indicators
Research outputs
Indicators
Research outcomes
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Indicators
Impact
Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
9.
Timelines, planning
Describe foreseen activities and expected output per half year (research, knowledge exchange and capacity strengthening)
(Keep the table limited to max. 1 A4)
Project duration:
Activities
Output
Year 1
1
st
half
2
nd
Year 2
half
1
st
5
half
2nd half
months
Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
Funds required
10. Budget estimates
Please note:
a)
Project duration options
18 months
24 months
Maximum requested grant (€)
255,000
340,000
Max. travel budget (% of total grant)
10 %
10 %
Max. budget for knowledge sharing
(% of total grant)
20%
20%
Obligatory kick-off workshop (€)
Max. 15,000
Max. 15,000
Obligatory end-off project workshop
(evaluation) (€)
Max. 15,000
Max. 15,000
Total budget overview
Project duration:
months
Requested contribution from this call (grant):
€
Co-funding contribution in cash (if applicable):
€
Co-funding contribution in kind (if applicable):
€
Total budget available for the project (grant + co-funding)
€
Total costs / budget line
Amount of
% of total
Additional
grant budget
grant budget
co-funding
(€)
(€) per
budget line
Personnel (i)
Research costs (ii)
- Travel costs
Knowledge sharing & capacity strengthening iii)
- Kick-off workshop
- M&E – end of project workshop
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Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
b) Budget specification
Costs requested from this call:
€
(i) Personnel costs
Name
Category (post-doc, PhD, senior, junior,
Salary per
support staff)
month (€)
TOTAL personnel costs
(ii) Research costs
Fte
Time
Amount (€)
(months)
€
(durables, consumables, travel costs, please specify)
TOTAL research costs
Amount (€)
€
(iii) Knowledge sharing, capacity
strengthening, M&E activities
Please specify
Amount (€)
TOTAL research costs
€
TOTAL:
€ …..
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Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
c)
Amount and source of co-funding, if applicable:
Expected in kind/cash contributions
Source co-funding
Amount (k € )
(specify budget items)
TOTAL
€…
d) Total available project budget: (b+c):
€
Ethical challenges
11. Ethical challenges
(Consider the ethical challenges of your project and ethical clearance; max. 400 words).
Signatures
By submitting this document, the applicants declare that they satisfy the nationally and internationally
accepted standards for scientific conduct as stated in the Netherlands Code of Conduct for Scientific
Practice 2012 (Association of Universities in the Netherlands:
http://www.vsnu.nl/files/documenten/Domeinen/Onderzoek/The_Netherlands_Code_of_Conduct_for_Sci
entific_Practice_2012.pdf)
Signatures of all consortium members as presented in section 3a of the application form are required.
Electronic and/or scanned signatures are accepted.
Consortium member - Main applicant/coordinator
Name:
Signature:
Consortium member - Co-applicant
Name:
Signature:
Consortium member - Co-applicant
Name:
Signature:
Consortium member – Co-applicant
Name:
Signature:
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Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
Submit this application electronically in PDF format through the Iris system of NWO. Please note that the
electronic application must be submitted through the Iris account of the main applicant. Main applicants
from non-Dutch organisations should register the application by filling in “NWO-SRHR”, “ ‘s-Gravenhage”
as the applying institute. Instructions on submission can be found in the Call for proposals and on the
SRHR-website.
Do not forget to attach the requested (and properly signed) annexes (see listing below)!
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Sexual and Reproductive Health and Rights: Bangladesh
Application form – Deadline 20 August 2015
Annex I. Literature references
A listing of literature references referred to under 6, Project description (max. 1 page).
Annex II. CVs of consortium members as listed under 3a
Note: Only CVs of the applicants employed by the consortium member organisations (3a) should be
submitted (max. 1 page each). CVs of project staff (3b) will not be accepted.
Annex III. Letters of support from consortium members
Letters of support (max. 2 pages each) should be addressed to the project leader and should reflect the
availability and guarantee to timely contribute to the project the commitments as described in the
application form (stating co-funding commitments if applicable).
Annex IV. Letter of support concerning use of data (if applicable)
A support letter of and singed by the beholder / legitimate owner of data stating the availability and use
of appropriate (micro-level) data and other statistics by the consortium for the project.
Annex V. Plan for the kick-off workshop.
See instructions in the call text (p. 28).
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