APPLICATION FORM FOR PARTNER NGOs

Please write your responses in block letters.

1. Name of the organization:

2. Address:

3. Pin code: Phone no.: Fax no.:

4. E-mail: Website address:

5. Head of the organization:

6. Contact person:

7. Phone no.: Mobile no.:

8. Details of staff

No. of full-time staff: No. of part-time staff/volunteers:

No. of consultants:

Please attach your employee organizational chart

9. Year of registration under the W.B. Society Registration Act 1961 and last date of
renewal:

10. FCRA no. (if any):

11. Office premises: Rented Own

12. Office space (in sq ft): Any Branch office: Yes/ No

13. Geographical coverage of current projects:

14. a. Annual budget for all programmes run by the organisation (2007-08) as per
the audited statement):

b. Annual Budget of the Education programmes run by the organisation (2007-

08):

15. No. of years organization has been working with disadvantaged children:

16. Details of at least 5 projects undertaken by the organisation in last 3 years

(Complete the template below):

1 CINI ASHA – The Urban Unit of Child In Need Institute / UTI / 2007
Sl Name of the Duration Funded Target Geographi Amount
no Project & by group & cal
Description No. of coverage (Rs)
(Not more Beneficiar
than 2 lines) ies

17. No. of child beneficiaries:

18.Activities (tick all that are appropriate)

Curriculum development

Teaching-Learning materials development (TLM)

Training (please specify the areas)

Community mobilization

Non-formal education

Retention of children in formal schools

Networking

Action research

Others (please specify):

2 CINI ASHA – The Urban Unit of Child In Need Institute / UTI / 2007
 19. Target Groups & mention the age group (tick all that are appropriate)
Target Groups Tick the relevant Mention the age group
options

Children of sex worker

Children with disabilities

Street children

Migrant population

Girl child

Slum children

Children with HIV/ AIDS

Child labourers

Child victims of
abuse/trafficking

Others (please specify)

20. Has the Organisation partnered or collaborated with any other NGO and /or
Government Department previously (If yes, mention the details in no more that 5 lines)

21. Organisational Profile

21a. Mission:
21b. Objectives:
21c. Achievements (Major Highlights):

22. Financial Profile

22a. Does your organization have a board-approved written financial guideline and/or
policies and procedures?

Yes No

22b. Does your organization have audited financial statements for the last three years?

Yes No

3 CINI ASHA – The Urban Unit of Child In Need Institute / UTI / 2007
22c. Does your organization accounting system have the capability to separate and track
donor funds?
Yes No

22d. What type of accounting procedure is used by your organization?

Manual Computerized (if computerized, name of the software)

Cash Basis Accrual Basis

23. Monitoring and Evaluation

23a. Has an evaluation of your project been done by external/donor agencies in the last
two years?
Yes No

23b. Do you have any internal monitoring systems in place? If yes, please describe
briefly (no more than 50 words).

24. Please list the names, designation and occupations of your Board members:

25. Write in not more than 100 words the areas of interest to expand the education
programme for Deprived Urban Children:

Signature: ………………………………………………………………………………………………………

Name: ………………………………………………………………………………………………………………

Designation:……………………………………………………………………………………………………..

Date: …………………………………………

4 CINI ASHA – The Urban Unit of Child In Need Institute / UTI / 2007
Checklist of Required Attachments
Please enclose copies of the following, tick those that are attached, and include this checklist
with your application packet.

A copy of your organization’s valid updated registration certificate and regular

renewals.

A copy of the Memorandum of Association along with a brief bio-data of each Board
Member. Profiles should include the members’ full names, their title or position in
the NGO, their relationship with any staff members (if any) and their roles and
responsibilities as Members of the Board.

Annual reports for the last three Financial Years.

Audited Statement of Accounts for the last three Financial Years.

A printed copy of your current annual budget.

A copy of your organization’s most recent Income Tax return.

A copy of the proposed project management structure as it relates to this project

and a brief description of how roles and responsibilities will be executed.

Brief bio-data of key project personnel.

Copy of formal agreements with the government (if any). The agreement could
be in education or other sectors.

A list of collaborating organizations, networks and alliances involved in

developmental issues, especially basic education.

Organizational handbook of policies and procedures (or Service Rules).

List of at least two and no more than five donor organizations

from which the applicant organization has received funds and a
brief (no more than a page) description of the project(s) funded.

A copy of the latest project evaluation report by your donor(s).

Brochures / handouts of the organization (if any).

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