Advocacy grant application form

OPEN SOCIETY ROMA INITIATIVE APPLICATION FORM FOR ADVOCACY GRANT

The Open Society Roma Initiatives seek to support NGOs carrying out advocacy work pursuing local and national policy agendas on Roma. In the context of the Decade of Roma Inclusion (2005-2015) priority areas (education, employment, health, housing), applications that seek to increase public awareness and support for the Decade; strengthen Roma participation in Decade-related processes at local and national levels; and contribute to monitoring progress and impact of Decade policies and programs are particularly welcomed. Advocacy projects that address other issues are also encouraged. These include those related to: anti-discrimination and equal opportunities; minority rights (e.g. identity, history, language, and media representation); combating violence and hate crimes; human rights and concerns of refugees, IDPs, returnees, asylum seekers; personal documents; and monitoring of elections. Supported projects should promote the active participation and leadership of Roma community members affected by the issues. For more information about the Open Society Roma Initiatives grantmaking priorities go to: http://www.soros.org/initiatives/roma/focus

1.

BASIC INFORMATION ON THE PROPOSED PROJECT:

a. Project title: b. Project beginning and end dates: c. Name of applicant organization. d. Address of applicant organization: e. List of partners in the project: f. Total project budget: g. Amount requested from Roma Initiatives: h. Confirmed and/or pending project support from other sources: i. Project Summary: (No more than 10 lines)

Advocacy grant application form

Advocacy grant application form

j. Please tick the appropriate boxes. Choose as many as appropriate for your project. For more information on the terms, see the Call for Proposals. What policy area(s) does your project address? [ [ [ [ [ [ [ [ [ [ [ Education Employment Health Housing Anti-discrimination/combating anti-Gypsyism Gender Youth Child poverty Early Childhood Education Roma and other stakeholder participation Human rights and concerns of refugees, IDPs, returnees, asylum seekers [ ] Combating violence and hate crimes [ ] Minority rights (language, history, media representation, etc.) [ ] Other (please specify) Provide additional details on the boxes selected above (optional): Here you may specify a particular issue you may be focusing on within the area marked above, such as health mediators, vocational training, and micro-credit schemes, etc. ] ] ] ] ] ] ] ] ] ] ]

Advocacy grant application form

2. ADMINISTRATIVE DETAILS OF THE APPLICANT ORGANIZATION:

Name of organization requesting grant Name of the signatory to the contract Address of the organization (Country, City, Street, ZIP code ) Telephone and Fax E-mail Website Name and address of the bank Name of the bank account holder (this should be the same as the name of the NGO requesting the grant) Bank account IBAN Name of the correspondent bank if necessary (usually in the case of the Western Balkans) City and Country of the correspondent bank Swift code of the correspondent bank

Advocacy grant application form

3. DESCRIPTION OF THE APPLICANT ORGANIZATION(S)

Please answer all of the following questions. Use more space as needed. Please feel free to attach additional information or achievements of the organization and partners to demonstrate their capacity and relevant experience. Describe when and how your organization was established? What is the mission of the organization? Provide a short description of the main activities over the last two years.

a)

b)

c)

d) What results has your organization had to date? Describe successful projects and their short and long term impact. e) What challenges or main lessons has your organization had to date? Describe when a project did not go as planned? How did the organization deal with it?

f) Please provide a brief description of current projects of the organization.

g)

List all of the organizations donors over the last three years. This should include current and past donors: Other donors besides the Open Society Foundations: Open Society Roma Initiatives: o Institutional support grant: o Project grants or others: Other programs/initiatives of the Open Society Foundations: National Open Society foundation (Soros foundation) in your country:

Advocacy grant application form

h) Provide the total annual expenditures of the organization for the last two fiscal years.

i)

Briefly outline the scope and amount of other proposals that the organization has already submitted or intends to submit to donors for funding.

j)

List the staff and main consultants who will work on the project. Include their names, titles and roles in the project. Attach full CVs of all relevant staff/consultants.

4.

PROJECT DESCRIPTION

Please answer all of the following questions. Use more space as needed. a. Issue and justification: Briefly describe the need for the project. What is the issue you have chosen to focus on, and why is it important to address now? If relevant, please indicate how the project responds to the Decade of Roma Inclusion process in your country or locality? b. Overall goal of the project: Describe in one or two sentences the overall goal of the project. c. Objectives: List the projects specific, achievable objectives. They should represent steps toward achieving the overall goal. d. Beneficiaries/Constituency: Who shall benefit from your project and how are they involved in the project? e. Advocacy targets: Who is being targeted by the advocacy activities of this project and why? Can you influence them directly? If not, which groups/audiences can influence these decision-makers and how will you reach these groups? f. Partners: List any partners you will work with, and include their previous experience and their roles in the project. How will you work with other organizations involved in similar advocacy efforts?

Advocacy grant application form

g. Methodology: Explain in detail the advocacy methods you will use, and why? If you are producing reports, describe your methods for a) data collection and analysis; and b) dissemination plan. If you have already developed concrete asks and recommendations, please include them here. h. Project Activities and timeline: Describe the activities planned. Provide a timeline for these activities. i. Results/Outcomes: List the expected outcomes of the project. What changes will result from the project? j. Potential risks: Please indicate potential risks that may prevent the project from realizing its objectives. How does your project address these risks?

5. MONITORING AND EVALUATION

Please answer all of the following questions. Use more space as needed. a. During the project, what will be the main monitoring and evaluation activities? b. What are the indicators that show the achievement of each objective/outcome? c. How will progress be measured? d. Is there any available baseline data? If so, what is it? e. What data sources and methods of data collection will be used to show progress toward each objective/outcome?

6. SUSTAINABILITY AND IMPACT OF THE PROJECT

Please answer all of the following questions. Use more space as needed. a. How will the activities be financed after the funding ends?

Advocacy grant application form

b. Describe potential for the project to be replicated; the outcomes to be extended or information generated further disseminated. c. What policy-level impact will the project have? For example, will it lead to improved legislation, policies or practices, new methods, new attitudes or awareness?

7. BUDGET
The amounts must be in US Dollars. Budgets submitted in other currencies will not be accepted.

Budget Summary
Budget categories TOTAL USD Supported by OTHER sources (Include both amount and the donor) REQUESTED from Roma Initiatives

1. Administration 2. Salaries 3. Conference/Meetings 4. Travel 5. Other TOTAL USD:

Detailed Budget
Please provide a detailed presentation of your project budget. Add more lines if necessary a. Administration

Advocacy grant application form

LIST TYPE OF EXPE NSES

EXPLANATION (days or month x rate)

TOTAL AMOUN T IN USD

OTHER (Include both amount and the donor)

REQUEST ED from Roma Initiatives

Telephone/fax Postage Office supplies

TOTAL ADMINISTRATI ON

b. Salaries If the budget includes salary costs, please include the full-time salary for each person and the percentage of time that your request represents.
NAME of employee/JOB TITLE Part or TOTAL FullMONTH time LY SALARY in USD % of time covere d by the projec t OTHER (Include both amount and source) REQUEST ED from Roma Initiatives

SALARY TOTALS

a. Conferences/Meetings
List Meetings and Location Explanation of costs TOTAL Cost In USD OTHER (Include both amount and source) REQUEST ED from Roma Initiatives

Advocacy grant application form

TOTAL MEETINGS

b. Travel
Travel Explanation (Purpose, number of persons, destination, mode of planned travel) TOTAL Cost OTHER (Include both amount and source) REQUESTE D from Roma Initiatives

TOTAL TRAVEL

e. Other
List Type of Expense (include external consultants here and other direct costs associated with the project) TOTAL Cost OTHER (Include both amount and source) REQUESTE D from Roma Initiatives

TOTAL

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Advocacy grant application form

I affirm that I have filled out the application accurately Name: Title: ________________________ ________________________ Date: __________________

Signature:________________________

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