Fund 2016_Applica… · Web viewThe Application Form for Japan Water Forum Fund 2016 *Before...

Application #JWF Fund 2016

The Application Form for Japan Water Forum Fund 2016

*Before filling out/submitting your application, please read through the guidelines.

*The applications using other formats cannot be accepted.

APPLICATION FORM [A]About your organization (Max. 2 pages)

*Please enter N/A if you have no affiliation. The applications with blank cannot be accepted.

1. Name of your organization:

2. Brief description of your organization

(Max. 150 words)

*Please give a brief and clear explanation of your organization.

3. Representative of your organization

Position: Name: E-mail address:

Mr. Ms. Mrs. Dr.

4. Contact person of your organization

Position: Name: E-mail address:

Mr. Ms. Mrs. Dr.

5. General information of your organization

Country: City:

Postal mailing address:

Telephone: Fax:

1


Website (Homepage, Facebook, etc.):

Q1. How many staff members (permanent, temporary, volunteer)?

XX (persons)

Q2. When was your organization established (year and month)?

XX/XXXX (month/year)

Q3. How much income/funding did you get last year? (USD)

XXXXXX (USD)

Q3-2. And what are the main income/funding sources?

Q4. Have you ever applied for a JWF Fund before? When was it?

YES/NO, XXXX (year)

Q5. Have you ever received a JWF Fund before? When was it?

YES/NO, XXXX (year)

Q6. What kind of projects have you implemented in recent years?

(Max. 150 words)

*Please give a brief and clear explanation of the past projects and its aim, contents, effects,

partners/donors/stakeholders.

6. Pictures of your organization

*Please attach pictures that were taken from outside and inside your office.

2


< Outside your office >

(e.g.)

<Inside your office>

(e.g.)

3


APPLICATION　FORM [B] About the project which will be implemented with the grants from the JWF Fund

(Max. 5 pages)*Please enter N/A if you have no affiliation. The applications with blank cannot be accepted.

2-

3-1. Project Name

(Max. 20 words)

*Please give a brief and clear name that describes your project.

2. Location

(Max. 50 words)

*Please give a brief description and address of the location and attach a map or photos of the

project’s location here.

3. Problems and background

(Max. 200 words)

4

Map or photographs


*Please give a brief description of water-related problems in your project implementation planned

site.

4. Photographs

*Please attach some pictures that show the above problems as well as current situation of the

project implementation planned site (with captions).

1) Caption:

2) Caption:

3) Caption:

5


4) Caption:

5. Category

*Please choose one category which is most applicable to the project and check the box .☑

⃞ Construction of the rainwater harvesting tank, well, and water reservoir.

⃞ Installation of the small scale type water supply system.

⃞ Construction and/or repair of the sanitation facility.

⃞ Implementation of the Water-related disaster risk reduction/mitigation program.

⃞ Maintenance and improvement of the water resources environment.

⃞ Installation and promotion of the water efficiency irrigation system.

⃞ Other (Please specify: )

6


(Max. 100 words)

*Please give a brief and clear description of your project’s objectives

6. Objective of your project

7. Detail of your project

(Max. 300 words)

*Please give a more in-depth description of your project. Please list the action items you will

implement and describe the details of each.

* If you plan to construct rain water harvesting tanks, wells, toilets or carry out workshops, please

clarify the number of them.

*If you plan to construct facilities for providing drinking water, it is necessary to check the quality of

water to see if it is suitable for drinking. Checking the quality of water and the cost of it shall be

included in the project plan.

*If you plan to construct toilet facilities, please describe sewage treatment method. E.g. septic

tank, single pit latrine, double pit latrine, etc.

*If you plan to do survey, the result of the survey should be reported to JWF in the project

completion report.

8. Sustainability

(Max. 200 words)

*Please describe how you would be able to establish and develop the sustainability. After the

project period, how the activities/facilities would take root in the project site? Who would be

responsible for?

7


9. Impact

(Max. 150 words)

*Please give a brief description of the prospective positive impact of your project on the problems

mentioned in “3. Problems and background”

10. Beneficiaries

(Max. 50 words)

*The reasons that the people are selected as beneficiaries. (Social, financial, ethical background)

*The total expected number (men/women/children) of direct beneficiaries of your project.

11. Beneficiaries’ contributions

(Max. 100 words)

*Please describe how you would get the beneficiaries’ contribution to your project. What will be

provided as contributions from the beneficiaries? E.g. materials, financial support, physical works

etc.

12. Stakeholder participation

(Max. 100 words)

*The stakeholders who will be involved in the project besides your organization and beneficiaries

should be clearly described with their role in the project.

8


13. Schedule

*The schedule of your project should be clearly described. The project shall be completed by the

end of February and the project report shall be submitted by 15th April 2017.

*The project period has been changed from JWF Fund 2015.

Item Nov. Dec. Jan. Feb. Mar. April

9


APPLICATION　FORM [C] About your project costs

* This budget chart shall be filled in using US$ totals.


Item Content Unit cost (US$) Quantity Amount (US$)

Total cost of completing your project

A: Local contribution, if any

B: Amount requested to the JWF fund (up to US$1,000)

(A+B) Total cost of completing your project

*It shall be the same as the above total cost.

10


APPLICATION　FORM [D] Other information


1. Which currency bank account does your organization have?

US$ / EUR / YEN

2. Remittance information:

*Please ask your bank if you do not know the details.

Account Name:

Address of Account Holder:

Country:

Bank Name:

Branch Name:

Account No.

IBAN Code:

SWIFT Code:

Address of Bank:

Country:

[Through]

3. Even though the grant is (up to) US$1,000, the net amount you will finally receive in your bank account may be lower, due to bank charges, transfer charges, etc. Do you agree with this?

*Please note that the JWF does not cover any remittance charges.

Yes / No

4. Do you agree that you will submit a report about the project with JWF Fund 2016 with some related pictures and actual expenditures by 15th April 2017, if you are selected as a recipient of the grant from the JWF Fund 2016?

11


*Please note that recipients of a grant from the JWF Fund must submit a report on the use of

the grant.

*Submitting the report is absolutely necessary:

- Donors need evidence the grant is used properly

- Other potential donors will access the project report and gain awareness through

your activities

- If you don’t submit the report, you will be ineligible for any future grants from us

and our partners

Yes, we will submit the report by 15th April 2017. / No

5. We will implement follow-up survey after the completion of the projects. Do you agree that you will submit a follow-up report about the project with some related pictures by 31 May 2018?

* Additional US$100 will be provided as a follow-up report fee.

Yes, we will submit the follow-up report by the end of May 2018. / No

5. Do you agree that your report, including pictures, will be used under the name of the Japan Water Forum?

Yes, we agree that our report, including pictures, will be used under the name of the Japan

Water Forum. / No

Do you agree that you will participate in occasional follow-up surveys of the JWF Fund? Yes, we will participate in the follow-up surveys of the JWF Fund. / No

Please note: The name of your organization, the name of your project as well as the results will be

published on the Japan Water Forum web site. Also, the pictures you provide to JWF will be used

under the name of JWF.

12

Fund 2016_Applica… · Web viewThe Application Form for Japan Water Forum Fund 2016 *Before...

Documents

Transcript of Fund 2016_Applica… · Web viewThe Application Form for Japan Water Forum Fund 2016 *Before...