Sector EducationHealthcareEconomic Development Organization Name Contact Name First Last Contact Title Legal/administrative structure: (What is your legal status, state when incorporated, how long in existence, how is the organization governed, number of full-time staff, what measures do you have for keeping grant funds separate from your operating funds) Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Office Phone Mobile Phone Fax Email* Name of Person Responsible for project implementation and administration of funds: Mission of organization (1-3 sentences) Amount (state whether JA or US Dollars) $ Project Start Date Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Project End Date Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 List dates of prior application for an AFJ Grant List AFJ grant awarded (year and $ amount) PROJECT SUMMARY Title of Project: Project Summary (3-5 sentences describing purpose of grant, program, and expected outcomes) Where will project activities take place? If you are seeking partial funding from AFJ for a larger project, which will involve funding from other donors, please state whether you have the other funds in place, and whether/how the project will go ahead if other donations are not forthcoming. Describe the need to be addressed by the project. Is there a specific problem which will be addressed, if so, describe the problem, how many people are affected by it, how adverse or critical is the problem to the wider society? Describe the objectives and activities of the project. Describe your institutional or other capacity to carry out the objectives above. Who will implement and monitor the project, and how? Who would benefit from the services and activities provided under this grant? How many people, what ages, where, what demographic, etc. Do you have any plan to continue the funded activities past the term of the grant? If so, please describe. Do you have specific measurable goals for the project? How will the benefits of this project be measured in relation to activities, achievement and objectives and possible partnerships? How will you know if the project has been successful? Do you plan to assess the project’s success? If so, how? What synergies might be realized, e.g., could the project be replicated elsewhere, be repeated the following year, or serve as a model for others? Is there any training aspect of the project? PROJECT BUDGET Please download the Budget Sheet, fill it out and upload it here. Upload your budget sheet as a Word Document, Acrobat PDF or Powerpoint.(File size should be smaller than 2MB). 2MB Limit. (File formats: pdf, doc, docx, ppt, pptx) Accepted file types: pdf, doc, docx, ppt, pptx. Please provide a copy of your organization’s last two (2) years financial statements. Upload your file as a Word Document, Acrobat PDF or Powerpoint. (File size should be smaller than 2MB). Accepted file types: png, jpg, gif, txt, doc, pdf, ppt, pptx. Please attach pictures of the recipients of the grant, if available (optional). One or 2 pictures only. (File size should be smaller than 1MB). Drop files here or Accepted file types: png, jpg, gif, txt, doc, pdf. ELECTRONIC SIGNATURE Name First Last Title Date Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Email This field is for validation purposes and should be left unchanged.
