IPPF small grants facility: Taking the ICPD beyond 2014, to position sexual and reproductive health and rights (SRHR) and the priorities of the ICPD in the next development framework

Instructions for Completing the Application Form

Please read the application guidelines carefully and complete all the sections. All pages must be submitted.

Checklist

Please make sure that all the necessary documents are attached:

 Completed application form  
 Certificate of Registration of your organization e.g. charity registration documents
Most recent audited accounts or financial statements

Applications and any questions should be sent by email or surface mail to:

		songsfund@ippf.org

	or	ICPD Grants Facility
IPPF	
		4 Newhams Row, London, SE1 3UZ	
		United Kingdom
		fax +44 (0)20 7939 8300

Deadline: 17:00 GMT, Sunday 17 August 2014

Section One: Activity Summary 

Activity Title: 	
Start Date:  	End Date: 	
Amount requested: US$                                     	10% match funding:	
Project Summary (150 words only):

Section Two:  Organizational Details

Name of applicant organization:
	
Contact person:
	Email:
	
Address:

	Tel:
Fax:
	
Do you have a certification of registration as a charity or NGO in your country?
•	Yes   (please provide a copy)
•	No    (ask another organisation to apply on your behalf)	
Organization’s overall budget for each of the last two years:
     2011 $
     2012 $	
Are you applying on behalf of an unregistered organization?
•	Yes   
•	No	
If your organization is collaborating with a partner, please give details. 

Name of partner organization:
Contact person:
Tel:
Email:

Section Three: Purpose and Outline of the Proposed Advocacy Activity (maximum 3 pages)

Background information and justification: 

•	What is your objective?
•	What results do you want to achieve?
•	Why do you want to achieve them?

Describe the Key Activities: 

•	Who are the people in positions or your target groups that can make this change happen? 
•	What is your strategy to reach these people to convince them that change is necessary? 
•	Who will you work with to reach these people and bring about change? 

Expected Advocacy Outcome: 

What change are you expecting to achieve with these activities? 

Does it relate to any of the below?

•	Working with governments who are sending delegations to global policy events 

•	Participation in global policy events and follow up advocacy and dissemination at the national level  

•	Influencing any of the following events (Delete as appropriate):  Open Working Group for the Sustainable Development Goals, Regional Population Conferences for the ICPD, Regional population conferences in 2013, the 2013 MDG Special Event, Commission on Population and Development and the UNGASS 2013/14 for the Millennium Development Goals and the ICPD;

•	Participation in government delegation at global policy event  

•	Have a clear plan for follow up work on accountability and transparency over the following 12 months, at national level 

	
Indicators which all grantees must report on 

1.	Proportion of CS representatives on national delegations at global policy events and 2013 baseline 
2.	Number and nature of supportive statements made by national governments on their position in accordance with global SRHR policy and 2013 baseline
3.	Level of awareness on position of SRHR in global policy and 2013 baseline:
a.	Volume and frequency of media coverage favouring SRHR
b.	Number and nature of inquiries from CSOs about SRHR 
	
Measuring Success: 

How will you know if you have made a change? How are you going to demonstrate that change? 
Please provide indicators and sources to measure the process and the success of your advocacy	

Partners: 

Who will be your partner (s), why and what will they do? 

Risk Assessment: 

What might stop you doing these activities?
What are the risks of doing these activities and how will you address them.	

Section Four: Budget (maximum one page)

Please specify which budget lines will be covered by your organization (you can use a different color). The budget lines below are examples and can be added to and changed as appropriate to the project activities.

SUMMARY	
PERIOD: Month/Year to Month/Year		
Total budget requested (local currency)		
Exchange rate		
Total budget requested (USD)		

Budget Line Description	Units

Units	Unit cost

	Total Requested

Total	Co-Contribution	
 					
 Travel  from… to…	# of journeys	@ 			
 Per diem					
 Accommodation	# of days x # persons				
 Meeting expenses					
 Publicity material 					
Other (please specify)					
Sub-total					
					
Total project expenditure					
Overheads (5%) –applied to total project expenditure					
TOTAL LOCAL CURRENCY					
EXCHANGE RATE USED					
TOTAL US$ 					

SECTION FIVE: Checklist

Please tick the box for the following documents necessary to make your application:

 Completed application form  

 Certificate of Registration of in-country organization

 Most recent audited accounts or financial statements