APPLICATION FORM · Web viewPlease be aware that the PEPFAR Small Grants program receives hundreds...

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PEPFAR Small Grants Program 2013-2014 DETAILS and APPLICATION FORM TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy Maseru [email protected] Special Projects Office http://maseru.usembassy.gov/grants.html P.O. Box 333, Maseru 100, Lesotho

Transcript of APPLICATION FORM · Web viewPlease be aware that the PEPFAR Small Grants program receives hundreds...

Page 1: APPLICATION FORM · Web viewPlease be aware that the PEPFAR Small Grants program receives hundreds of applications, but there are limited funds available. Remember, only projects

PEPFAR Small Grants Program 2013-2014

DETAILS and APPLICATION FORM

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html P.O. Box 333, Maseru 100, Lesotho

Page 2: APPLICATION FORM · Web viewPlease be aware that the PEPFAR Small Grants program receives hundreds of applications, but there are limited funds available. Remember, only projects

PEPFAR Small Grants Program: 2013-2014

GRANT DETAILS

Thank you for your interest in the PEPFAR Small Grants program. The 2014 grant application period is now open until April 30, 2014.

Overview

Funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the PEPFAR Small Grants program is for community-initiated projects which aim to strengthen health service delivery in communities affected by HIV and AIDS. The program supports community groups who support orphans and vulnerable children (OVC) and community-based HIV and AIDS palliative care and home health care initiatives.

Projects funded under this program are required to have community support in the form of money, labor and/or other services. The greater the involvement and contribution from the local community, the more likely the grant request will gain approval. Projects should aim to make a long-term impact in their communities and move towards sustainability. After the grant money is used, the project must be able to continue on its own or with forthcoming help from the community and/or other donors.

Grants are awarded for a one year period and usually range from $5,000 to $25,000. Each organization that is funded will be required to measure and report the results it achieves by following PEPFAR and the U.S. Department of State’s reporting requirements.

Consideration will only be given to projects which:

• Address the needs of OVC and/or support community-based HIV and AIDS palliative care and home health care

• Have at least eight project members

• Improve basic economic or social conditions at the local community or village level

• Support high impact, quick implementation activities that benefit a substantial number of people within one year without requiring further assistance or funding

• Are oriented toward communities, not individuals

• Involve at least a 10% contribution of cash, labor, or materials by members of the local community

• Are within the ability of the local community to operate and maintain

• Are managed and run by local Basotho groups, e.g. community-based organizations, faith-based organizations and/or groups of people living with HIV or AIDS

• Can be measured through tangible results and reports, e.g. number of people supported and/or trained

• Are a direct response to the initiative and aspirations of the local community

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 1 P.O. Box 333, Maseru 100, Lesotho

Page 3: APPLICATION FORM · Web viewPlease be aware that the PEPFAR Small Grants program receives hundreds of applications, but there are limited funds available. Remember, only projects

PEPFAR Small Grants Program: 2013-2014

Grant Conditions

PEPFAR Small Grants program funds can be used for:

• Home-based caregiver kits and medical supplies• Training for caregivers and care providers• Equipment for OVC centers• Educational materials and training supplies• Equipment, materials and technical training for income-generation projects• Ongoing administrative or operating costs (but no more than 10% of total requested funds budget)• Structured and measurable prevention and awareness campaigns, workshops and outreach sessions

PEPFAR Small Grants program funds cannot be used for:

• Remodeling or renovating an existing facility that is in disrepair as a result of neglect or lack of money• Projects managed by private businesses, private crèches or public schools• Food and food parcels• School uniforms, school fees or student bursaries• Salaries and/or personal expenses• Motorized vehicles or tractors• Pesticides, fungicides, and herbicides• Office equipment such as computers, fax machines, or photocopiers• Military activities (including those relating to police, prisons or other law enforcement activities)• Activities with unmitigated and negative environmental consequences, e.g. dams or forest roads

Measurable Results Requirement

PEPFAR Small Grants program funds can only be used for projects which are able to measure and report on how they contribute to HIV/AIDS and OVC care. Projects must be able to count or describe the following on a quarterly basis:

Orphans and Vulnerable Children (OVC) Projects • Services provided (e.g. healthcare, shelter, child protection, HIV and AIDS prevention education)• Number of children served • Number of providers and/or caregivers trained

Community-based Palliative and Home Care Projects • Number of individuals provided with general HIV-related palliative and home care• Type of care provided (such as physical, spiritual, psychological, or social support)• Number of caregivers trained to provide general HIV-related palliative and home care

Expenditure Reporting

If awarded a grant, you must account for all of the grant funds by keeping original receipts for every use of funding. These will be checked at least twice during the grant year. If receipts are not accounted for, all further funding to your group will be discontinued.

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 2 P.O. Box 333, Maseru 100, Lesotho

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PEPFAR Small Grants Program: 2013-2014

GRANT DETAILS

Rea leboha ha o bots’intse thahasello ea hao Lenaneong lena PEPFAR Small Grants program. Likopo tsa lithuso bakeng sa 2014 li butsoe ho fihlela ka 30 ‘Mesa 2014.

Kakaretso

PEPFAR Small Grants program ke lenaneo la sachaba le reretsoeng ho ntlafatsa litsebeletso tsa bophelo libakeng tse angoeng ke HIV/AIDS. Le ts’ehelitsoe ka lichelete ke U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Lenaneo lena le ts’ehetsa lihlopha tse ts’ehetsang bana ba likhutsana le ba tlokotsing, le ba fanang ka lits’ebeletso tsa kalafo tsa malapeng le tlhokomelo ho bakuli le batho ba phelang le HIV.

Merero e thusoang ka lichelete ke letlole lena e lebeletsoe ho ba le ts’ehetso ea sechaba, ekaba ka lichele, ka matsoho kapa lisebelisoa. Ho ts’ehetsa le ho kenya letsoho hoa sechaba morerong ho eketsa monyetla oa hore kopo tsa chelete ea morero e ananeloe. Merero e lokela ho ikitlaellatsa ho fihlela katleho ea nako e telele e tlisang phetoho maphelong a sechaba. Tebello ke hore merero e khone ho itjara kamora hore thuso ea chelete ho tsoa ho ‘Muso oa Amerika e emise.

Tebello ke hore chelete ena ea ts’ehetso e be sebelisitsoe ka nako ea selemo, ‘me hangata lenaneo lena le fana ka chelete e lipakeng tsa $5,000 and $25,000 (M50,000 le M250,000 re ipapisitse le maemo a moruo a ha joale). Sehlopha se seng le se seng se lebeletse ho fana ka litlaleho tsa likatleho tseo o se fihletseng se ipapisitse le lipehelo tsa ‘muso oa Amerika le letlole la PEPFAR.

Merero e tla shejoa haholo-holo ke ee:

Ts’ehetsang bana ba likhutsana le ba tlokotsing, le ba fanang ka lits’ebeletso tsa kalafo tsa malapeng le tlhokomelo ho bakuli le batho ba phelang le HIV

Nang le litho tse robelI (8) ho ea holimo

Ntlafatsang maphelo a batho metseng le metsaneng eo ba phelang ho eona

Ts’ehetsang sehlopha kapa batho ba bangata ka nako ea selemo ba bile basa hloke ts’ehetso e ngoe

Thusang sechaba eseng batho ka bo mong

Sechaba se ka kenyang letsoho ho eona (10%), ekaba ka chelete, matsoho kapa lisebelisoa.

Sechaba se ka itsamaisetsang eona

Tsamaisoang ke lihlopha tsa Basotho metseng joalo ka lihlopha tsa ts’ehetso tsa HIV/AIDS, mekhatlo metseng, likereke

Fanang ka litlaleho tse bonahalang ha bobebe joalo ka lipalo tsa batho ba ts’ehetsoang ke morero kapa ba fumaneng koetliso

Arabelang ka kotloloho boikitlaetso le litaba-tabelo tsa sechaba

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 3 P.O. Box 333, Maseru 100, Lesotho

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Lipehelo

Chelete ea lenaneo lena la HIV/AIDS metseng e ka sebelisoa ho etsa tse latelang:

Ho reka litlhare le lisebelisoa tsa ho okela bakuli malapeng Koetliso bakeng sa bahlokomeli ba bakuli Ho reka thepa sebelisoang mahaeng a lIkhutsana le bana ba tlokotsing Ho reka lisebelisoa tsa thuto le koetliso Ho reka thepa le ho fana ka koetliso bakeng sa merero e tlisang phaello Ho lefa tsamaiso ea ofisi (feela e se fete 10%) Ho etsa mats’olo a ho elellisoa sechaba ka litaba tsa HIV/AIDS

Chelete ea lenaneo lena la HIV/AIDS metseng e keke ea sebelisoa ho etsa tse latelang:

• Ho fetola le ho lokisa meaho ea khale e senyehileng ka lebala ho se hlokomeloe kapa tlhokahalo ea lichelete

• Ho ts’ehetsa merero ea batho ka bo mong e sa tsoeleng sechaba molemo J.K. likhoebo tsa batho ka bo momg, likolo tseo e seng tsa sechaba kapa tsa ‘muso

• Ho reka lijo• Ho reka seaparo sa sekolo, lihlapiso tsa sekolo• Ho lefa Meputso ea basebetsi• Ho lefella litlhoko tsa motho ka mong• Ho reka makoloi kapa literekere• Ho reka menont’sa, libolaea likokonyana le lehola• Ho reka thepa ea liofisi joalo ka li komporo, thepa e fotang j.j• Merero ea masole, mapolesa, lichankana le mafapha a mang a ts’ireletso• Merero e ka tlisang litlamorao tse mpe tse amang tikoloho joalo ka matamo kapa litsela tse tsamaeang

kahara meru

Litlaleho

Chelete ea lenaneo lena la HIV/AIDS metseng e ka sebelisoa bakeng sa merero e tla fana ka litlaleho tse hlakileng tse bonts’ang na morero ka mong o kentse letsoho joang tlhokomelong ea batho ba angoeng ke HIV/AIDS le bana ba likhutsana le ba tlokotsing. Merero e lebeletsoe ho fana ka litlaleho tse bonts’ang lipalo palo tse latelang:

Merero ea bana na likhutsana le ba tlokotsing Palo ea lits’ebeletso tse fanoeng (J.K. ts’ehetso ea lijo, bolulo, ts’ireletso ea bana, thuto ka ho thibela

HIV/AIDS le litaba tsa HIV/AIDS ka kakaretso) Palo ea bana ba thusitsoeng Palo ea ba fanang ka lits’ebeletso ea tlhakomelo ba koetlisitsoeng

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 4 P.O. Box 333, Maseru 100, Lesotho

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PEPFAR Small Grants Program: 2013-2014

Merero ea tlhokomelo le ho okoa hoa bakuli malapeng Palo ea ba fihletsoeng ka lits’ebeletso tsa ho oka le ho hlokomela bakuli Mofuta oa tlhokomelo o fanoeng (J.K. ‘meleng, moeeng, kelellong, le bophelong ka kakaretso.) Palo ea bahlokomeli ba fuoeng koetliso ea ho fana ka lits’ebeletso tsa ho oka le ho hlokomela bakuli

malapeng

Merero e lebelletsoe ho fana ka litlaleho tse kang tsena kotara e ngoe le e ngoe.

Tlaleho ea ts’ebeliso ea lichelete

Haeba merero oa hao o ka fumana thuso ea chelete, o lokela ho boloka ka hloko bopaki (rasiti) ba tsohle tseo o sebelisitseng chelete holima tsona. Ofisi ea rona e tla hlahloba litokaomane tse bonyane habeli ka selemo ho netefatsa hore o ntso o ipapisitse le tumellano ea rona le uena. Haeba o sa tlise litlaleho, kapa litokomane tse pakahatsang ts’ebeliso ea chelete li sieo, ts’ehetso eohle ea chelete e tla emisa.

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 5 P.O. Box 333, Maseru 100, Lesotho

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PEPFAR Small Grants Program: 2013-2014

APPLICATION REQUIREMENTS

The application period for grants is open until April 30, 2014.

In order to apply you must provide the following by the deadline:

Completed application form (attached). Detailed answers must be provided for all questions in order for your application form to be considered.

A detailed history of your organization and project stating when it started, what has been accomplished, what you have done for the community, and how the community supports you.

A copy of your organization’s constitution.

A list of committee members with their names and addresses. The minimum number of project members required to apply for funding is eight.

Three complete estimates for each service or item you are requesting funds for. You must have three estimates to cover all funds that you request.

A copy of project bank account details including the name of the bank, account name, account number and type of account (savings or checking).

Proof that the project has its own land (in the name of the project), or permission to occupy the land, e.g. signed lease agreement or land deed.

A map showing how to get to your project from a major road.

A business plan for any income-generation activities your project will support with the funds. This includes detailed information about your operations, market, expenses, and objectives. You can obtain a business plan template from the U.S. Embassy reception desk. With this you may attach any other documents which you feel will help your application.

If your organization’s application has been short-listed, you will hear from the Special Projects Office by 31 May 2014. Please be aware that the PEPFAR Small Grants program receives hundreds of applications, but there are limited funds available.

Remember, only projects who meet the criteria outlined in this application and who include all of the required documentation will be considered.

Thank you for your interest and GOOD LUCK!!

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 6 P.O. Box 333, Maseru 100, Lesotho

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Tse hlokahalang ho etsa kopo

Likopo tsa lithuso bakeng sa 2014 li butsoe ho fihlela ka 30 ‘Mesa 2014.

Ho etsa kopo ea ts’ehetso ea chelete, le lokela ho fana ka litokomane tsena tse laoelang:

Foromo ea kopo e tlatsitsoeng ka botlalo e le ho eketsa menyetla ea lona ea hore moerero oa lona o tle o atlehe ho fumana ts’ehetso.

Nalane ea mokhatlo kapa morero oa lona, na o qalile neng, tseo le li fihletseng, o thusitse batho ba phelang tikolohong ea ona joang, ‘me bona ba le ts’ehetsa joang.

Kopi ea moleo theo oa mokhatlo kapa morero.

Lenane la litho tsa komoti, fanang ka mabitso a feletseng le liaterese.

‘Mapa o bots’ang na mokhatlo kapa morero oa lona o fumaneha hokae.

Likhakanyo tse tharo tsa lintho tseo le li kopang ho tsoa ofising ea rona.

Kopi e bots’ang lintlha tsa polokele ea banka ea mokhatlo, lebitso la polokelo, nomoro, le mofuta oa polokelo.

Bopaki bo bonts’ang hore mokhatlo kapa morero o na le tumello ea ho sebelisa sebaka sa ts’ebetso. E.g Tokomane ea tomellano ea ts’ebeliso ea mobu.

Kenyeletsang le moralo oa khoebo o bonts’ang moralo oa ts’ebetso, mmaraka, lits’enyehelo le seo le batlang ho se fihlela. Foromo e le tataisang ho etsa moralo ona oa khoebo le ka e fumana liofing tsa rona. Le ka kenyeletsa litokomane tse ling tseo le hopolang hore li ka matlafatsa kopo ea lona.

Haeba kopo ea sehlopha sa heno e hloauoe, ofisi ea Special Projects e tla ikopanya le uena pele ho Mots’eanong. Elang hloko hore makholo-kholo a lihlopha a etsa likopo selemo le selemo, emba ba atlehang ke ba tllatsang foromo ea kopo ka botlalo.

Hopolang hore ke merero e ipapisitseng le lipehelo tsa rona, e bile e fane ka litokomane tsohle tse hlokahalang e tla ts’ehetsoa.

Re leboha boikhathatso ba lona ebile re le lakaletsa katleho!!!

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 7 P.O. Box 333, Maseru 100, Lesotho

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PEPFAR Small Grants Program: 2013-2014APPLICATION FORM

GROUP INFORMATIONLintlha kholo tsa sehlopha

Please print carefully in block letters, except where signatures are requiredNgola ka litlhaku tse balehang ntle le moo ho tekenoang

1. Name of GroupLebitso la sehlopha      

2. LocationSebaka      

3. Mailing AddressLebokose la poso      

4. DistrictSetereke      

5. Name of Project ManagerLebitso la mookameli      

6. Project Manager TitleMaemo ka mokhatlong      

7. Address of Project ManagerAterese ea mookameli      

8. Telephone Numbers, if anyLinomoro tsa Lifono / mehala. Le tsa litho feela

If you do not have a telephone, please supply us with some means of contacting the project (for example, another telephone in your area, a radio and/or an authorized Maseru contact) (Ha e-ba fono ha e e'o, fana ka sebaka kapa fono ea moo re ka siang molaetsa teng.)

     

     9. Project Manager Signature

Tekeno      

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 1 P.O. Box 333, Maseru 100, Lesotho

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PEPFAR Small Grants Program: 2013-2014APPLICATION FORM

PROJECT INFORMATIONLintlha kholo tsa morero

10. Please give a brief description of your group and its purpose. Ka bokhuts’oanyane hlalosang mokhatlooa lona le sepheo sa oona.

     

11. When was your group (school, clinic, business, etc.) started?Sehlapha o qalile neng?

Month       Year      Khoeli Selemo

12. Does your group have a constitution? If yes, please include this with your application.Na le na le molao oa motheo? Haeba le na le ona, o qhaoelleng kopong ea lona.

YES (Ee) NO (Che)

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 2 P.O. Box 333, Maseru 100, Lesotho

Page 11: APPLICATION FORM · Web viewPlease be aware that the PEPFAR Small Grants program receives hundreds of applications, but there are limited funds available. Remember, only projects

PEPFAR Small Grants Program: 2013-2014APPLICATION FORM

13. Please provide names of the following elected officers of your group:Haeba karabo e le Ee, fana ka mabitso a:

Chairperson/President      Molula-setulo

Vice-chairperson      Motlatsi

Secretary      Mongoli

Treasurer      Ramatlotlo

14. What is your government registration number or license to operate as a clinic, a business, a co-operative, an association, an NGO, or a charity organization (etc.)?Fana ka nomoro ea lakesense kapa lengolo la tumello ea ho ba mokhatlo le tsoang ho ‘muso.

     

15. Please describe the community that your project serves (e.g. population, unemployment rates, infection rates, type of housing).Ka bokhuts’oanyane hlalosang na sehlopha sa lona se fana ka ts’ehetso ho bo mang (J.K. Lipalo tsa ba thusoang, ke ba bakae ba hlokang mesebetsi, ke ba bakae ba phelang le HIV, mokhoa oa bolulo j.j).

     

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 3 P.O. Box 333, Maseru 100, Lesotho

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PEPFAR Small Grants Program: 2013-2014APPLICATION FORM

16. What is your project idea? Provide specific details of your project and explain exactly how you plan to use the grant money. Also detail what you already have and what you will plan to do in the future. Morero oa lona ke ofeng? Hlalosang hore na chelete ea lithuso e tla sebelisoa joang. Hlalosang na le na le eng hona joale ‘me le rerile ho fihlela eng kamoso.

If your project involves any income-generation activities please submit a Business Plan.Haeba morero oa lona e le oa khoebo, kenyeletsang moralo oa lona oa khoebo.

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 4 P.O. Box 333, Maseru 100, Lesotho

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PEPFAR Small Grants Program: 2013-2014APPLICATION FORM

17. BUDGET ESTIMATES FOR MATERIALS, EQUIPMENT AND/OR LABOR REQUESTED (Provide additional sheets if required)

ITEM: BRIEF DESCRIPTION OF MATERIALS, EQUIPMENT AND/OR LABOR FROM EACH SUPPLIERTlhaloso ea sohle se hlokahalang ka bokhuts’oane

TOTAL COSTKakaretso ea Theko

NAME OF SUPPLIER/VENDORLebitso la Morekisi/Mosebetsi

                 

                 

                 

                 

                 

                 

                 

                 

                 

GRAND TOTAL      

*Important* Attach at least three quotations from each vendor/supplier/contractor with costs and items to be purchased. The Grand Total should equal the amount you are requesting and cannot exceed R250,000. Be sure to include all costs related to the project. These may include: training, medical kits, transportation, cost of campaigns, funds required for any materials or supplies for income-generation activities, etc.Fana ka lethathamo la lintho tsohle tseo u hlokang ho thusoa ka tsona. Batla likhakanyo tse tharo bakeng sa mofuta o mong le o mong oa thepa ho barekisi kapa ba fani ba lits’ebeletso J.K. koetliso, meriana, maeto, mats’olo, thepa ka mefuta ea eona eohle. Kopanya feela e le ‘ngoe ea khetho ea hao likhakanyong ka ho fapana u ntse u ipapisitse le hore ha u fete R250,000 e boletsoeng e le moeli.

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 5 P.O. Box 333, Maseru 100, Lesotho

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18. What is the total amount you are requesting from the fund? Kakaretso ea chelete eo le e kopang e kae?

     

19. We expect the group to contribute at least 10% of the project costs in cash, labor and/or materials. Given this, please answer the following:Re lebeletse morero ho fana ka bonyane 10% ea litjeho, e ka ba ka chelete, matsoho kapa lisebelisoa:

a) How much cash can you contribute?

Chelete eo le ka e khonang ke bokae?      

b) What will you purchase with this money?E tla reka eng?

          

c) What materials can you contribute?Lisebelisuoa tse ka fanoang ke mokhatlo oa lona e ka ba life?

               

d) What is the approximate cash value of these materials?Lisebelisuoa tseo sehlopha sa lona o ka fanang ka tsona li ka qosa bokae?      

e) What labor can you contribute? What will the laborers do?Le ka fana ka basebetsi, ba tla sebetsa eng morerong oo oa lona?

          

     

f) What is the approximate cash value of labor?Haeba le ne le ka patala basebetsi baa ba ne ba ka qosa morero bokae?      

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 6 P.O. Box 333, Maseru 100, Lesotho

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20. What does the group already have that can be contributed to the project (for example, tools needed to carry out the project, a building to use, a vehicle, etc.)?Ebe morero o se o ntse o e-na le thepa ea mofuta ofeng e ka thusang ho o ntsetsa pele, mohlala koloi, moaho, lithulusu, joalo-joalo.

     

21. Do you own the land or property to be used, or have permission to use it for the project? Sets’a seo le il’o sebeletsa ho sona ke sa lona, kapa le na le tumello ho sebeletsa moo?

YES (Ee) NO (Che)

If yes, please provide a photocopy of the document showing your right to use the land or property. Haeba ho le joalo, fanang ka bopaki ba set'sa kapa bopaki bo bonts’ang hore le na le tumellano ea ho sebelisa sets’a se joalo.

22. Does your group have outstanding loans or debts? If so, please explain how these will affect your project.Na sehlapha sea kolota? Ha e ba ho joalo, sekoloto se se tla ama morero joang?

     

23. Please provide details about how you plan to pay for maintenance of the supplies or equipment purchased for this project. Bontŝa hore na le tla hlokomela morero joang kapa thepa ea oona.

     

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 7 P.O. Box 333, Maseru 100, Lesotho

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24. What is the long-term vision of your group? Where do you see this project in five years?Bontŝa meralo ea nako e telele ea morero eo mohlomong e ka amang morero/le lakatsa hore morero oa lona o be o le hokae kamora lemo tse hlano?

     

25. If this is a business or income-generating activity, please submit a business plan. Explain what gross income you expect, what profit you can make, and what funds will need to be reinvested. If you need help with this, business plan templates are available from the U.S. Embassy reception desk.Haeba morero e le oa ho etsa chelete, fana ka moralo oa khoebo. Bontsa chelete e lebeletsoeng, liphaello, le hore na matsete e tla ba a makae, haeba le hloka thuso ho etsa moralo ona, liforomo tse ka le tataisang lia funameha ofising tsa rona.

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 8 P.O. Box 333, Maseru 100, Lesotho

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Additional Project and Group InformationLintlha tsa tlatsetso haeba li le teng

26. Please provide details about the people supporting this project.Ka kopo fanang ka palo ea batho ba nkang kaolo morerong oa lona.

a) Total number of people actively supporting the projectKakaretso ea batho ba ithukhubetsang ka matla morerong      

b) Total number of caregivers supporting the projectKakaretso e aba fanang ka tlhokomelo      

27. Please provide details about the people who will benefit from this project.Ka kopo fanang ka palo ea batho ba tla thusoa ke morero ona.

a) Total number of people who will benefit from the project

Kakaretso ea batho ba tla thusoa ke morero ka kotloloho      

b) Number of males who will benefit from the projectBa batona ba bakae      

c) Number of females who will benefit from the projectBa bats’ehali ba bakae      

d) Total number of project membersKakaretso ea litho tsa morero      

e) Number of male project membersBa batona ba bakae      

f) Number of female project membersBa ba bats’ehali ba bakae      

g) Number of children who will benefitBan aba bakae      

h) Number of patients who will benefitBakuli ba bakae      

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 9 P.O. Box 333, Maseru 100, Lesotho

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28. How will the project members benefit from the project?Hlalosa hore na ba tla khola molemo joang?

     

29. How will the community members benefit from the project?Hlalosa melemo eo ba tla e fumana?

     

30. What measurable results did your program achieve last year?Ke life tseo morero o ileng oa li fihlela selemong se felileng?

a) Number of Orphans and Vulnerable Children served last yearLenane la ban aba likhutsana le ba tlokotsing      

b) Number of patients cared for last yearLenane la bakuli ba hlokometsoeng      

c) Number of community members educated on HIV/AIDS Prevention and Awareness last yearBatho ba khahlanyelitsoeng ka lithuto tsa tsebo le boits’ireletso lefung la HIV le AIDS      

d) Any other measurable results you tracked last year?Ke life hape tseo morero o ileng oa li fihlela selemong se felileng?      

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 10 P.O. Box 333, Maseru 100, Lesotho

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31. Has your group ever received financial assistance from the U.S. Government or another funding agency? A na 'muso oa America o kile oa thusa morero oo kapa mofani emong feela?

YES (Ee) NO (Che)

If yes, from which organization(s) was aid received, for what purpose, and in what year?Haeba ho joalo, bolela na e ne e le molemong oa eng, le selemo.

     

32. No project can be accepted for funding without a prior site visit. Please give directions to your site and draw a sketch map. You may use the other side of this sheet of paper.Ha hona morero o tla fumana ts’ehetso re s aka ra o etela pele. Fana ka ‘mapa oa moo morero o leng teng. Re tla sitoa ho thusa morero oo re e-so o bone. Hlalosa hore na re ka fihla morerong joang.

     

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 11 P.O. Box 333, Maseru 100, Lesotho

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For your application to be considered you MUST attach the following documentation. Please tick the box once you have included each component in your application.

Completed application form with detailed answers for all questions. A detailed history of your organization and project. A copy of your organization’s constitution. A list of committee members with their names and addresses. Three complete estimates for each service or item you are requesting funds for. A copy of project bank account details. Proof that the project has its own land (in the name of the project) or permission to occupy the land. A map showing how to get to your project from a major road. A business plan for any income-generation activities your project will support with the funds.

Incomplete applications will not be considered. Applications will not be returned so please retain a copy for your records.

*******

Bakeng sa hore kopo ea lona e atlehe, qhoaellang litokomane tse latela. Ts’oaea lebokose ha le qeta ho qhoaella tokomane ka ngoe.

Foromo ea kopo e tlatsitsoeng ka botlalo e le ho eketsa menyetla ea lona ea hore moerero oa lona o tle o atlehe ho fumana ts’ehetso.

Nalane ea mokhatlo kapa morero oa lona, na o qalile neng, tseo le li fihletseng, o thusitse batho ba phelang tikolohong ea ona joang, ‘me bona ba le ts’ehetsa joang.

Kopi ea moleo theo oa mokhatlo kapa morero. Lenane la litho tsa komoti, fanang ka mabitso a feletseng le liaterese. ‘Mapa o bots’ang na mokhatlo kapa morero oa lona o fumaneha hokae. Likhakanyo tse tharo tsa lintho tseo le li kopang ho tsoa ofising ea rona. Kopi e bots’ang lintlha tsa polokele ea banka ea mokhatlo, lebitso la polokelo, nomoro, le mofuta oa

polokelo. Bopaki bo bonts’ang hore mokhatlo kapa morero o na le tumello ea ho sebelisa sebaka sa ts’ebetso. E.g

Tokomane ea tomellano ea ts’ebeliso ea mobu. Kenyeletsang le moralo oa khoebo o bonts’ang moralo oa ts’ebetso, mmaraka, lits’enyehelo le seo le

batlang ho se fihlela. Foromo e le tataisang ho etsa moralo ona oa khoebo le ka e fumana liofing tsa rona. Le ka kenyeletsa litokomane tse ling tseo le hopolang hore li ka matlafatsa kopo ea lona.

Foromo e sa tlaotsoang ka botlalo e keke fumana ts’ehetso.Ipolokele kopi ea kopo ea hao hobane re keke ra khutlisetsa liforomo tsa likopo ho lona.

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 12 P.O. Box 333, Maseru 100, Lesotho

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FOR THE COMMUNITY Sebakeng sa motse

____________________________________Signature Tekeno

____________________________________Name (Print)Lebitso le ngotsoe ka botlalo)

____________________________________TitleMaemo

____________________________________Date Letsatsi

LOCAL AUTHORITY(Chief, Village Council, District Administrator, etc.)(Morena, Molula-Setulo oa Council, Mongoli oa Setereke, joalo-joalo)

____________________________________Name (Print) Official stamp here Lebitso le ngotsoe ka botlalo Setempe sa molao mona

____________________________________Title Maemo

____________________________________Date Letsatsi

TEL: +266 2231 2666 FAX: +266 2231 0116 U.S. Embassy [email protected] Special Projects Officehttp://maseru.usembassy.gov/grants.html 13 P.O. Box 333, Maseru 100, Lesotho