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					Activity Concept form for the Pacific Public
Sector Linkages Program 2010-11
Closing time and date: 5pm AEDT, 12 March 2010
Maximum length: 2 pages

The page limit is strictly two pages. The only exception is if you need to include detailed budget explanatory notes –
these may be submitted on a third page. Do not alter the margins or font size. Do not include any attachments.
Applications not complying with these conditions may be rejected. (Delete this note from your final application).

1. List the partner country, countries or regional organisation(s)

2. Provide details of the applicant organisation and Concept contact officer
Concept contact officer: Name:
                          Postal address:
                          Telephone & facsimile numbers:

3. Name public sector counterpart organisation(s) in partner country/countries or, if working with a regional
organisation, the specific work unit

4. Provide Activity Concept name

5. Provide the estimated start and finish dates
Start                                 Finish

6. Describe the broader development issue the Activity would address

7. Describe briefly and clearly the Activity Concept (This should include the development outcome the Activity aims to
achieve. Does this Activity Concept fill a clear need in the partner country/countries or regional organisation?)

8. Explain how the Concept meets the Pacific PSLP aim of building linkages and capacity (Which linkages will be
built and will they endure beyond the Activity? How will the counterpart organisation be strengthened?)

9. Explain how the Concept addresses the Pacific-specific assessment criteria (see Pacific PSLP Guidelines)

10. Describe the approach or strategy to achieve the Concept’s objective and the inputs to be provided (When
and where will inputs occur and who will undertake them?)

11. Describe your organisation’s present linkages with the proposed counterpart organisation(s) (Has that
organisation indicated in-principle support for the Activity Concept, and how was it involved in its development?)

12. Will women face barriers in participating in activities such as training or staff exchanges? How will these
barriers be addressed?

Australian Agency for International Development
255 London Circuit Canberra ACT 2601  GPO Box 887 Canberra ACT 2601  Telephone +61 2 6206 4000  Facsimile +61 2 6206 4880
         13. Explain why your organisation is unable to fund the proposed Activity from its own resources

             14. Estimate the Activity budget (A$, excluding GST) (lines can be deleted if not applicable)

                                                                          Applicant           Counterpart            Third party      PSLP funds
                                                                        contribution          contribution          contribution       requested         Total

                                                                        Note: Use an asterisk (*) to indicate in-kind contributions

             Applicant organisation personnel - salaries
             Applicant organisation personnel - travel
             Applicant organisation - admin support1
             Counterpart organisation -salaries                                                                                              n/a
             Counterpart organisation - travel
             Consultancy costs, if any2
             Overheads & on-costs, if any3                                                                                                   n/a
             Other (specify)
             Pacific PSLP funds requested as a proportion of total Activity costs                                                             %
             Note: All eligible cost categories are defined in the section ‘Eligible costs’ of the Pacific PSLP Guidelines.

         15. Financial year break-down
         2010-11: $                  2011-12: $                                          2012-13: $

         1     Pacific PSLP funds can be used for administrative support costs up to an additional 10% of the value of funds sought from AusAID.
         2     Please include all travel, insurance and living costs.
         3     Pacific PSLP cannot meet any overhead costs. Under the Pacific PSLP Guidelines on-costs and overheads are regarded as a cost-sharing contribution
               by the applicant organisation.

2 of 2   AusAID Activity Concept form for the Pacific Public Sector Linkages Program 2010-11