The World through Colour and Sound

Application form
Identification data Project name: Organization/Institution: Total project value: Requested amount: Implementation period:

............................................................................... ............................................................................... ............................................................................... .......... representing .. % of the total project value ...............................................................................

Contact information Contact person: E-mail: Telephone: Postal address: Web site:

............................................................................... ............................................................................... ............................................................................... ............................................................................... ...............................................................................

How did you find out about the Orange Foundations grant? by email: . by newsletter: please specify. on the internet: please specify the website . by recommendation from: other: .

I. Applicant information Name of the organization: ............................................................................... Legal registration form: NGO Educational institution Health/medical institution

Cultural Institution Founding date: Legal representative: .................................

Other (please specify)

...............................................................................

Please list your governing structure (please give the complete name of the members of the Board and the organizations where they work): ............................................................................... ............................................................................... ............................................................................... Number of employees: ........................... Number of volunteers: ......................................... Participation in networks or coalitions: ....................................................................... Organization information Please include a short description of the applicant organization/institution (mission, objectives, main programs implemented in the last two years relevant for this project, beneficiaries (Type and numbers). Please include the information in max 2 pages.

Last Annual budget of the organization, in tabular format, listing main financial contributions and expenditure categories. Please add lines as needed. INCOME Income source/type

Amount (RON)

Total EXPENDITURES Category

Amount (RON)

Total Please mention bellow if the organization has been audited recently and attach the financial auditors letter with the other annexes.

II. Project description Location: What is the geographic scale of the project (local, regional, national). In which cities will the project take place? Addressed need or opportunity (maximum 1000 characters) Please describe in 2,3 paragraphs the need or opportunity your organization identified in the community. Please mention the groups affected, the specific need or opportunity you want to address and the long-term impact on these groups if the need is not addressed. Project Goal (maximum 1000 characters) Considering the identified need, mention in one paragraph what change does your organization want to obtain by implementing this project. Main partners - please mention partners that you wish to attract in this project (if the case) ..............................................................................................................................................

Objectives (maximum 1000 characters) Please mention as specific as possible how your organization plans to reach the project goal. (maximum 3 objectives) 1. ....... 2. ..... 3. ........ Beneficiaries Please describe the beneficiaries included in the project: number, age, and characteristics relevant for the project. (max. 1 page) If the target groups are different from the beneficiaries please list them as well. Activities and major milestones Include activities linked to each objective. Please describe the activities in order to offer a clear image about the necessary steps for implementing the project, resources and time. Please use the Gant table below to show the activities' flow during the project. This will also help your organization to see how activities and resources overlap during the project implementation.

Activity/month Ob. 1 Ac. 1.1. Ac. 1.2 Ac. 1.3 Ob.2 Ac.2.1 Ac. 2.2 Ac. 2.3 Ob. 3 Ac. 3.1 Ac. 3.2 Ac. 3.3

M1

M2

M3

M4

M5

M6

M7

M8

M9

M 10

M 11

M 12

(please state the name of the activity in the first column and thick the corresponding months) Major milestones that you will achieve: Key performance indicators for the project objectives and of the activities plan Please describe the KPIs & evaluations methods your organization will consider in order to register the changes the project lead to for beneficiaries and communities. Please offer a list of clear indicators (quantitative and qualitative) that you will consider. 2014 Quarterly split * Q2 Indicator 1.1... Correspondent activity 1 Correspondent activity 2 ... Indicator 1.2 ... Correspondent activity 1 Correspondent activity 2 ... Indicator 1.3... Correspondent activity 1 Correspondent activity 2 ... Q3
Q4 Q1 Q2 2015 Sources and ways of cheking

Indicator 2.1... Correspondent activity 1 Correspondent activity 2 ... Indicator 2.2 ... Correspondent activity 1 Correspondent activity 2 ... Indicator 2.3... Correspondent activity 1 Correspondent activity 2 ... Indicator 3.1... Correspondent activity 1 Correspondent activity 2 ... Indicator 3.2 ... Correspondent activity 1 Correspondent activity 2 ...

Indicator 3.3... Correspondent activity 1 Correspondent activity 2 ...

* Pleasde mention only the indicators that will be achived in the correspondent quarter (do not summarize the achievements from the previous quarters);Please adjust the table according to the number of your activities. Please enumerate the main activities that are contributiong to reaching the targets (outputs).
Project team (maximum 3000 characters) Please describe the project team (expertise and professional development) and the roles within the project for each team member. Risks (maximum 1000 characters) Please report any in this section any potential risks that might prevent you from implementing the project or parts of it (regarding project management, partnerships, socio-economic context etc.) Sustainability (maximum 1000 characters) Please shortly describe the way your organization will secure financial security of the project after Orange Foundation grant will end. Please consider that the partnership may last only for one granting round. Please describe the solutions your organization considers, based on the financing solutions identified. Results (maximum 1000 characters) Please describe the results generated within the beneficiaries. Remember, results must indicate the change generated within the beneficiaries. Do not limit your projections to process indicators (ex. Number of participants in an event of number of work meetings). Try to identify the changes generated as a result of project activities. Impact (maximum 1000 characters) Please describe long term changes you anticipate to generate due to this project Project promotion/visibility Please describe how does your organization intend to promote its activities communication channels, target groups. Please provide a detailed and comprehensive communication plan (ex. number and timing of the press releases, of the press conferences, of newsletters, social network activities, etc.).

Budget Please offer a detailed description of the project costs based on the activity plan. Mention your organizational contribution in the project, requested contribution from Orange Foundation and any other external sources you intend to approach for supplementary contributions*. Non-eligible costs Organizational costs, other than those directly linked to the project Scholarships, academic research or studies for organizational staff or beneficiaries. We do not support humanitarian trips, conferences, camps or similar events. Activities that take place outside Romania

Category

Unit

Cost/ Unit (RON)

No. of units

Total cost (RON)

NGO Contribution (RON)

Comments Requested amount (RON)

Salaries linked to the project, collaborations Project team a) Project manager b).. c)..
Subtotal

Direct Costs Beneficiaries transport Meals Therapy sessions Project visibility .

Subtotal
*

In case you wish to attract the support (in cash or in-kind from other companies please offer information about potential partners in order to avoid discrepancies in expectations.

Administrative costs 1. Utilities 2. Monthly Rent 3. Communication (phone, etc) 4. Supplies 5. Personnel/volunteers transport 6. Promotion (banners, promotional materials, film production, etc.)
Subtotal

Subtotal

Subtotal TOTAL

III. Annexes Mandatory annexes 1. Last annual organizational report (in Romanian) 2. Team members resumes (in English) 3. A document (one page) describing other type of partnerships linked to the project (if relevant) (in English) 4. A copy of the last annual balance sheet. (in Romanian)

5. Project summary presentation in English, in power point (maximum 5 slides, excluding information about the organization) Non-mandatory annexes Audit report for the previous year As part of the pre-selection phase, Orange Foundation reserves its right to request additional documents such as: 1. Scanned copy of the organizational bylaws or any other legal document 2. Documents attesting professional service accreditation (if necessary) If the documents contradict the information on the Application Form, or they reveal any reason for non-eligibility, the project is automatically disqualified. Only the above listed documents will be sent to Orange Foundation. IV. Application timeline Launching date for the competition: 18th of December 2014. Deadline for sending the application: 27th of January 2014, 13.00. Organizations will submit only one project. Each application will receive a confirmation message on the communication address you have included in the Application Form. All application received after 13.00 p.m. will not be taken into consideration. Please send the Application Form and Annexes on the following address: fundatia.orange@orange.com Attention! The messages MUST NOT exceed 7MB. If they do please send the documents through wetransfer.com website. (do not use any other transfer website and please state the name of the project and of the NGO in the message box on wetransfer) Fundatia Orange is not offering further feedback on criteria of selections other than the ones stated in the application guide. The winning NGOs will be made public through press release.

Orange Foundation Romania does not take the responsibility to return copies of the received documents.

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