MAINSTREAMING DISABILITY INTO COMMUNITY-LED GENDER BASED VIOLENCE RESPONSES

APPLICATION FORMAPPLICATION CHECKLIST:

Completed application form A detailed activity based budget with clear line items

Programme related costs - Material, training, travel, commodities, meetings

Human resources - Staff salaries and other benefits Overheads - Telephone, IT, rent, utilities

A detailed work plan over 10 months A M&E framework An organogram CV of key staff working on project NPO registration documents

1. ADMINISTRATIVE INFORMATION 1. Date of submission of

application:

2. Organisation name:

3. Name and position of contact person:

4. Province:

5. Phone number:

6. Fax number:

7. Email:

8. Physical address:

9. Postal address (if different to the physical address):

10.In no more than five sentences, what does your organisation do? For example, what type of organisation is it, what is your core business, and who are the people you serve?

11.NPO number:

12.When was the organisation established?

2. REQUEST FOR FUNDING

CONTEXT AND PROBLEM STATEMENT13.Describe the context

in which you work. For example, urban/rural, demographics, main form of employment, biggest challenges faced by the community, etc.

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14.Why is it important to address GBV in your community? Please describe the issue, how it affects the community, and what its main causes are.

15.Please describe the GBV programming you are already doing and what you have achieved so far

PROJECT DESCRIPTION:JGF will consider proposals from community based organisations working to combat GBV by mainstreaming disability into their programmes.

16.What is the overall goal of your intervention?

17.In relation to this goal, what specific results or changes do you want to achieve? Please list no more than three.

18.In no more than three sentences, what activities will you undertake in order to

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achieve these results?

19.a. How many people will benefit from this project?

b. How will they benefit?

20.How will you involve your community in your proposed intervention(for example through volunteering, materials and/or financial support).

3. ABOUT THE ORGANISATION

STAFF, MANAGEMENT AND GOVERNANCE21.Please list your staff

and volunteers, and indicate for each person their position, their gender, whether they are a staff member or a volunteer, and whether they are part-time or full-time.

Name Position

Gender

Staff/ volunteer

Part-time/ full-time

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Women Men Other

23.a. Please list your management team.

b. Briefly describe how the management structure of the organisation works.

Name Position Gender

24.a. Please list your board members.

b. Briefly describe the role of the board in your organisation.

Name Position Gender

25.What skills do the staff and board bring to the organisation? Please mention any training/mentorship that individuals or the organisation have had.

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26.How often does the staff of the organization meet? Please mark the correct box.

Never: Daily:

Sometimes: Weekly:

Monthly:

MEASURING PROGRESS AND IMPACT31.How do you propose to

measure the progress and impact of your proposed intervention? (Please attach a Monitoring and Evaluation plan)

NETWORKING, COLLABORATION AND PARTNERSHIPS32.How do you collaborate

and network with others (for example, other civil society organisations, and government departments)? Please give some examples.

Organisation/group How you collaborate

FINANCIAL INFORMATION

33.How are finances recorded and accounted for in your organisation?

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34.Do you have audited financial statements?

Yes: No:

35.Do you have an annual work plan and budget?

Yes: No:

36.Have you received funding before? If yes, complete the table:

Received from (funder) Amount

Purpose (for

what?)

For what period of

time?

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4. BUDGET AND WORKPLAN

Activities

What is it, when will it take place, who will be involved, how long will it be for etc.

Target groups

Who will be targeted by each activity?

Timeframe

When the activity will happen

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BUDGET

Line item Amount budgeted (ZAR)*

1. STAFF COSTS (SALARIES, STIPENDS ETC)

SUBTOTAL:

2. PROJECT COSTS

2.1. ACTIVITY 1

2.2. ACTIVITY 2

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2.3. ACTIVITY 3

Other Activities

SUBTOTAL:

3. ADMINISTRATION COSTS

SUBTOTAL:

TOTAL:

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