NOT FOR SALE ANTI-CHILD TRAFFICKING
PROGRAM
PARTNER APPLICATION
Please complete the following proposal for 2015 project funding
1. APPLICANT DETAILS
Please provide the following:
1.1 Organization Name (officially registered name)
1.2 Executive Director (full name)
1.3 Primary Contact Person (full name)
1.4 Organization Address(es)
Please provide the addresses for all project sites
1.5 Email Address(es)
Please provide the email addresses for the following individuals
1.5.1 Executive Director
1.5.2 Primary Contact
1.6 Telephone
1.7 Fax
1.8 Website Address
2. BACKGROUND INFORMATION
Please describe the following:
2.1 Mission
Describe the organization’s mission (max 200 words)
2.2 History
Please describe the organization’s history, including the number of years’ experience
providing services to survivors of human trafficking or individuals meeting Not For Sale
criteria for “at-risk” (max 400 words)
2.3 Target Population
Please describe the target population served by the organization, including gender, age,
nationality, ethnicity etc. (max 200 words)
2.4 Main Activities
Please describe the organization’s main activities (max 400 words)
2.5 Impact to Date.
Briefly describe the organization’s impact to date (max 400 words)
2.6 Financial Stability
2.6.1 Please describe any income generating program activities that support the
financial sustainability of the organization e.g. selling products or providing services
that return income to the program (max 200 words)
2.6.2 What portion of the organization’s annual operating budget is covered by
these income generating activities?
3. GOVERNANCE
Please describe the following:
3.1 Leadership and Staffing
3.1.1 Describe your leadership, staff, members, and their roles in decision-making,
and the organization’s decision-making process (max 300 words)
3.2.1 Provide brief biographical information about your key staff. Please include the
number of years and a description of relevant professional experience delivering
programs to survivors of human trafficking or individuals meeting Not For Sale
criteria for “at-risk” (max 300 words)
3.2.2 Are all employees paid at or above national industry average, and does your
organization offer paid and unpaid time off, in accordance with national standards?
3.3 Board of Directors
3.3.1 Please provide a list of names of the organization’s Board of Directors and job
titles
3.3.3 How many are foreign Board members?
4. FINANCES
Please provide the following:
4.1 Total annual operating budget
4.2 Accounting
4.2.1 Describe the organization’s accounting processes and the individuals involved
(max 300 words)
4.2.2 Does the organization have experience in international accounting standards?
4.2.3 Does your organization complete an annual financial audit?
4.3 Funding Sources. Please provide a breakdown and describe the main sources of funding
for your organization (max 300 words)
5. PROGRAM DETAILS
Please provide the following:
5.1 Program Title
5.2 Program Budget (total operating budget)
5.3 Geographic Region Served (max 200 words)
5.4 Problem to be Addressed (max 200 words)
5.5 Program Description (max 500 words)
5.6 Target Beneficiaries
5.6.1 Describe the persons who will directly benefit, including number, age group,
gender, nationality, ethnicity etc (max 300 words)
5.6.2 Describe the persons who will indirectly benefit, including number, age group,
gender, nationality, ethnicity etc (max 300 words)
5.7 Program Impact (Grant Period: July - December 2016)
5.7.1 Program Goal(s)
5.7.2 Program Activities
5.7.3 Program Outputs
5.7.4 Program Outcomes
5.8 Risk Analysis
5.4.1 What are the risks identified by the organization to successful completion of
the program? (max 300 words)
5.4.2 How does the organization minimize the identified risks? (max 300 words)
5.4.3 What are the risks that the intervention will not be implemented as planned?
(max 300 words)
6. BUDGET
Please attach a line-item budget detailing the annual cost for the proposed program. Please
use the following categories listed for all expenses, and include notes to describe the items
listed):
Program Expenses
Salaries
Marketing Expense
Facilities Expense
Telco
Office & Admin Expense
Travel & Entertainment
Professional Services & Consultants
Employee Development
7. GRANT MANAGEMENT
7.1 Program Manager
7.1.1 Please provide a resume and contact details for the Program Manager who will
be overseeing the grant.
7.1.2 Can the Project Manager speak and write English? If yes, who else aside from
the Project Manager speaks and writes in English?
7.2 Program Staff
6.2.1 Proposed program staff positions and their duties relative to the overall
implementation of the program (max 500 words)
7.3 Monitoring and Evaluation
7.3.1 Describe the average period of care for program beneficiaries
7.3.2 What is the length of follow up/ care for beneficiaries exiting the program?
7.3.3 Please describe the organization’s case management system, and the
information collected about program beneficiaries (max 500 words)
7.3.4 Please describe the organization’s process for tracking beneficiary progress
through the program (max 500 words)
8. BANK DETAILS
8.1 Please provide the organization’s bank account details
AUTHORIZATION
Please sign below to confirm that the information contained in this form and in any
supplementary paperwork or information is accurate. Once signed, please send the
completed application to Hannah Darnton at [email protected].
Please note that any misleading or fraudulent information supplied in this Partner
Application form will result in the immediate return of all grant monies and possible legal
action against the applicant.
Date:
Project:
Total Grant Amount Requested (not including additional projects):
Signed:
Position:
For and on Behalf of: