Conv2005 IFCD Form PP INGO 2012 EN by hRZ8UtFO


									                                  International Fund for Cultural Diversity (IFCD)
                                            Application Form for Programmes/Projects
                               for International Non-governmental Organizations (INGOs)

                              NB: Parties and national NGOs must fill out a separate form

                     The IFCD provides support for programmes/projects aimed at facilitating the introduction of
                     cultural policies, strengthening institutional infrastructure , providing capacity building
                     opportunities, fostering new cultural industries and protecting cultural expressions at risk.
                     APPLICATION PROCEDURE:
                     INGOs should email scanned versions (PDF format) of their signed Application Forms to:
            If scanning facilities are unavailable, signed original
                     versions of Application Forms should be sent to: Secretariat of the 2005 Convention on the
                     Protection and Promotion of the Diversity of Cultural Expressions, Division for Cultural
                     Expressions and Heritage, UNESCO, 1 rue Miollis, 75732 Paris Cedex 15, France.

                     Each INGO may submit a maximum of two applications that present programmes/projects
                     with a demonstrated impact at the sub-regional, regional or inter-regional level.
                     Applications are also to be accompanied by letters of support from beneficiary countries
                     from the sub-region/region(s). These are requirements for submission.
                     APPLICATION DEADLINE:
                     The deadline for the UNESCO Secretariat to receive funding applications from INGOs is
                     30 June 2012, midnight CET.

                     Applications received after this deadline will not be eligible for evaluation.

                                                                                                        Form n° 
                                                                                              (to be completed by UNESCO)

1. Name of applicant:
   This entity will be responsible for implementing the project, including its financial management.

2. About the applicant
   Please note that the applicant will need to have a bank account registered in the name of the
   organisation if the project is approved.

    2.1. Main mission and activities of applicant:
    Please provide its date of establishment, main activities, website and any other relevant information
    to show its direct relevance to the objectives of the Convention.
    (Max. 400 words)

  For the purpose of the IFCD, institutional infrastructure should not be interpreted as physical construction or
restoration but rather as management, human resources, etc.

International Fund for Cultural Diversity - Application Form for Programmes/Projects - 2012                         1
    2.2. International character of the NGO:
    Please provide the following material demonstrating the international nature of your NGO:
    •      a copy of your Statutes (with an English or French translation if necessary),
    •      a list of members / countries,
    •      a list of recent activities that have been carried out in different countries around the world.

    2.3. Name and position of key staff members directly employed by the applicant and working
         on the programme/project:
        Please list all key persons working on the proposed programme/project, their position in your
        organization and their main activities/areas of responsibility.

3. Title of the programme/project:

4. Length of programme/project:
    Please note that programmes/projects must begin in March 2013 at the earliest. UNESCO cannot
    issue contracts for approved programmes/projects prior to this date.

        Beginning date:                                                     End date:

5. Brief summary of the programme/project:
        Please provide a brief summary description of the programme/project. A more detailed description
        of activities and expected results is requested in sections 11 and 14 below.
        (150 to 250 words)

6. Fields of activity of the IFCD addressed in the programme/project:
        Please indicate which fields of activity of the IFCD are covered by the project (see paragraph 6.1
        of the Guidelines on the use of resources of the Fund adopted by the Conference of Parties in
        June 2009). Check more than one box if necessary.

            introducing cultural policies and/or strengthening the institutional infrastructure;

            strengthening existing cultural industries or creating new ones.

7. Regional context and justification of the programme/project
        7.1. Please identify and explain the specific needs, priorities and challenges (economic, political
        and social aspects) faced by the sub-region/region(s) your programme/project is targeting, and
        indicate how this project is designed to respond to them in a direct manner.

        (Max. 400 words)

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     7.2. Please provide information about other actors working in your field of activity and
     programmes/projects already started at the sub-regional, regional or inter-regional level
     responding to the specific needs, priorities and challenges previously described. Indicate whether
     and how these actors and/or programmes/projects will be associated with your project, and what
     value your funding request adds to the work that is already being carried out in your field.

     (Max. 400 words)

8. Objectives:
     Please describe the specific objectives of the programme/project (and not of the applicant),
     making sure to clearly explain the regional character of the programme/project. These should be
     in accordance with the main objectives and priorities of the IFCD (see Explanatory Note). Please
     distinguish between your short term and longer term objectives.
     Please indicate how these objectives contribute to the promotion of gender equality and/or youth
     in the fields of activity of the IFCD.

     (Max. 400 words)

9. Beneficiaries:
         Please specify which sub-region and/or region(s) will benefit from the implementation of your
         programme/project and how, and provide a letter of support from each Party beneficiary of the

     (Max. 200 words)

10. Implementation partners:
    Please provide a list of partners with whom you will be working to implement the
    programme/project on the ground.

11. Main activities of the programme/project:
     Please describe the proposed activities, the location(s) where they will be held and number them
     in the order in which they will take place. Information about activities to be undertaken to raise
     awareness of the programme/project in your sub-region and/or region(s) should also be included.
     You may wish to group the activities (research, workshops, publications, consultations, promotion,
     etc.) into distinct categories such as, but not limited to:

     -      capacity-building;
     -      mapping/inventorying;
     -      promoting exchange, interaction and network-building;
     -      awareness-raising and visibility.
     Please make sure that each activity corresponds to the objectives, as described in section 8, to
     the expected results, as described in section 14, and to the budget, as described in section 16.

     (400 to 800 words)

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12. Activities implementation schedule:
      Please provide an implementation schedule for your activities in the table below, making sure to
      note the beginning and end dates of all activities.

      NB: As stated in section 4, programmes/projects cannot start earlier than March 2013.

      Description of Activity                                        Beginning date                 End date

13. Contractors, subcontractors, consultants and experts:
    Please list the diverse contractors, subcontractors, consultants and/or experts who will participate
    in the implementation of the activities of the proposed programme/project who are not employed by
    your organization. Please indicate each person’s specific field of competence, role(s) and
    responsibility(ies), as well the reason(s) for which the applicant is calling upon their intervention. All
    paid interventions must be reflected in the budget.

      Indicate whether: contractor,                Field of expertise, role(s) and            Reason contractor,
      subcontractor, consultant or                 responsibility(ies)                        subcontractor, consultant
      expert                                                                                  or expert is being engaged

14. Expected results:
     Please use the table below to clearly indicate the expected results of your programme/project and
     indicate how you will know whether such results have been achieved. The expected results should
     be concrete and measurable and will serve as the base for the evaluation of the
     programme/project after its completion. The results should be correlated with the objectives,
     activities and budget, described in sections 8, 11 and 16 respectively, including those that pursue
     the promotion of gender equality. The number of expected results must match the number of
     activities listed under section 12.

      Expected Results                             Indicators                                 Means of verification

       *   Indicators are used to measure progress related to an expected result or an aspect of it.
       ** Means of verification are data sources and methodologies used to measure and analyze

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15. Sustainability:
     Please explain the expected impact of your programme/project on the emergence of a dynamic
     cultural sector, on sustainable development and on poverty reduction in the targeted sub-region
     and/or region. Describe the short (immediately following the end of your programme/project),
     medium (within five years) and long-term (within 15-20 years) conditions that would enable your
     programme/project’s gains to be sustainable.

     (Max. 400 words)

16. Budget
    16.1. Budget summary:
         Total funding requested from the IFDC (may not exceed USD100,000):                        USD
         Total co/self-funding:                                                                    USD
         Total project cost:                                                                       USD

    16.2. IFCD funding budget breakdown:
     Please fill in the table below with information on all foreseen expenditure items and their cost in
     USD for the amount of IFCD funding requested (the total amount of this budget must match the
     USD figure quoted on the first line of section 16.1). At the end of the programme/project, all
     original invoices and supporting documents must be sent to UNESCO. A pro forma invoice for
     equipment will be required.
                                                                 Activity      Unit      # of    Unit rate         Cost
                                                                   N°                    units   (in USD)        (in USD)

                                                                                              Total costs :
    * See Annex 1 to this Form for a sample budget.
    ** As a guide, it is advised that overhead costs should not exceed 7% of the total budget.
    *** Expenditures such as the purchase of a vehicle or construction / renovation of a building are not
        eligible for IFCD funding.

    16.3. Total project cost breakdown:
         If the funds requested from the IFCD will only cover a portion of a larger programme/project,
         please provide the provisional budget for the entire programme/project by filling in the table
         below with information on all foreseen expenditure items and their cost in USD. Please specify
         the amount that will be IFCD, self or co-funded. In the case of co-funding, please indicate
         whether or not additional resources are already available or when they are likely to become
         available and by whom. Written confirmation of co-financing may be requested.

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                                                                                                         Amount    Amount
                                                                   # of        Unit rate        Costs
                   Expenditure                         Unit                                              funded    co/self-
                                                                   units       (in USD)       (in USD)
                                                                                                         by IFCD   funded

                                                                           Total costs :

     IFCD funding                                                                             USD
     Self-funding                                                                             USD
     Co-funding (list all sources)                                                            USD
     Total programme/project income                                                           USD

17. Non-financial contributions. If any, of what kind and from what sources?

18. Previous funding from UNESCO for similar or related programmes/projects:
    If you have ever received any funds from UNESCO (either from Headquarters, a Field Office or an
    Institute) to implement (a) programme/project(s) similar to or related to the project that you are
    currently proposing, please provide below detailed information on its title, period, contract number,
    funding source, etc.
    (Max. 400 words)

19. Contact person for correspondence:

  Title (Ms/Mr, etc.):

        Family name:

         Given name:


   Complete mailing

Telephone number:

         Fax number:

     E-mail address:

       Other relevant

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20. Commitment to submit a report on the execution of the programme/project:
     As stated in paragraph 18 of the Guidelines on the use of the Fund: “The applicants shall submit a
     mandatory descriptive, analytical and financial report on the execution of the programme/project
     and the realization of expected results. The report must be presented to the Secretariat six months
     after the conclusion of the programme/project as foreseen within the time frame. No financial
     contributions for new projects will be allocated to applicants who have not submitted this report.”
     The full text of Article 18 is available at:

          I commit to respect the provisions of paragraph 18 of the Guidelines.
          I certify that all information contained in this application is truthful.


     Name and title

     Stamp and signature of the applicant

     NB: This application is not valid and cannot be accepted by the UNESCO Secretariat unless
     it is signed.

International Fund for Cultural Diversity - Application Form for Programmes/Projects - 2012           7
                                                      Annex 1: Sample budget
        You may wish to use the suggested budget model below. Please note, however, that you should only
        use the sections relevant to your programme/project and adapt it as necessary.

                                                                     Activity            Unit         # of      Unit rate     Costs
                                                                       N°                             units     (in USD)    (in USD)
1. Salaries / fees
1.1 Project staff                                                                   Per month
1.2 Experts / consultants                                                          Per day/week
1.3 Administrative / support staff                                                  Per month
Subtotal salaries / fees
2. Travel and per diem
2.1 Air transportation                                                               Per flight
2.2 Land transportation                                                            Per day/week
2.3 Visa fees                                                                       Per person
2.4 Per diem for international missions / trips                                      Per day
2.5 Per diem for domestic missions / trips                                           Per day
2.6 Seminar / conference participants                                                Per day
Subtotal travel and per diem
3. Equipment and supplies
3.1 Rent of vehicle(s)                                                              Per vehicle
3.2 Equipment (total based on pro forma invoice
enclosed with the application)
3.3 Other (please specify)
Subtotal equipment and supplies
4. Communication
4.1 Publications (editing, design, printing, etc.)
4.2 Press conferences
4.3 Other promotional activities, events,
advertisements, etc. (please specify)
Subtotal communication
5. Other costs, services
5.1 Studies, surveys (purchase of data)
5.2 Evaluation
5.3 Translation, interpreters
5.4 Rent of conference/seminar rooms
5.5 Other (please specify)
Subtotal other costs, services
6. Overhead
6.1 Rent of office space
6.2 Postage, office supplies, etc. (please specify)
6.3 Other (please specify)
Subtotal overhead

NB: Overhead costs should not make up more than 7% of total direct costs of the programme/project.

                                                                                                              Total costs

        International Fund for Cultural Diversity - Application Form for Programmes/Projects - 2012                         8
                                                Annex 2: Checklist

Please go through the checklist below prior to submitting the Application Form.


    1        Original signature of the person empowered to sign it on behalf of the applicant.

             Application prepared in English and/or French (requests in other languages will
             not be retained).

             All sections of the application form are filled in, respecting word counts indicated
             in each section.

    4        Expected results correspond to the main activities.

    5        Detailed budget breakdown is provided in USD and by type of expenditure.

             Application to be sent electronically to the UNESCO Secretariat. If scanning
             facilities are unavailable, applications must be sent by post.

                              Annex 3: Evaluation Grid (for information)

                  Evaluation criteria                                          Score (number of points)

Relevance/appropriateness of the project to the                                          from 0 to 4
fields of activity of the IFCD

Feasibility of the proposed programme/project                                            from 0 to 4

Expected results                                                                         from 0 to 4

Potential impact                                                                         from 0 to 4

Levels of funding requested from the IFCD                                                from 0 to 4

        4           meets entirely the criteria established by the Conference of Parties and the
                    Intergovernmental Committee
        3           addresses the majority of the criteria
        2           addresses half of the criteria
        1           addresses less than half of the criteria
        0           does not address the criteria at all

International Fund for Cultural Diversity - Application Form for Programmes/Projects - 2012               9

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