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					        GLOBAL POVERTY ACTION FUND (GPAF): IMPACT GRANT
                     CONCEPT NOTE FORM



This concept note form is designed to allow you to record all of the information that DFID
needs to assess the eligibility of your proposed project. Your concept note should set out
the underlying idea of the proposal and what your project would deliver.

It is very important you read GPAF Frequently Asked Questions before you start
working on your concept note to ensure you understand and take into account the criteria
of the fund.

Applicants must also complete the first two columns and activities log of a DFID
standard logical framework template. For guidance on logical frameworks please refer
to the How To Note.

IMPORTANT INFORMATION ON COMPLETING THE CONCEPT NOTE FORM
      The concept note form must be completed using Arial font size 12.
      Each concept note form must be saved as a separate file in Word format (*.doc).
      Sections 1 to 4 of the concept note form must not exceed a total of 6 (six) A4
       pages.

Concept notes which do not conform to the above criteria will not be considered.

SUBMITTING YOUR CONCEPT NOTE
You must send both your completed concept note form and your logical framework with
the first two columns and activities log completed by email to GPAFimpact@dfid.gov.uk .

If you have not previously received GPAF support, you must also send:
      An electronic copy of your organisation’s constitution
      A short background note on your organisation (max 1 A4 page in Arial Font 12)

We do not accept hard copies. Concept notes received after the deadline will not be
considered.

You may submit up to 3 concept notes in each funding round. Each concept note
must be submitted in a separate email.
                 GLOBAL POVERTY ACTION FUND (GPAF): IMPACT GRANT
                              CONCEPT NOTE FORM


SECTION 1: BASIC INFORMATION
1.1    Project title
1.2    Country(ies)
1.3    Locality(ies)/Region(s) within
       country(ies)
1.4    Project duration                             months
1.5    What is the likely total cost of the £
       project? In GBP sterling
1.6    Total funding requested from £
       DFID for this project In GBP                        %
       sterling and as a % of total project
       funds
1.7    Amount and source of match £
       funding In GBP sterling and as a %                  %
       of total project funds
1.8    ACRONYMS Please list all acronyms used in your application, spelling out each one in full


1.9    Implementation Partner(s) List all partners, putting the main partner first. This list must
       include all offices of the applicant that have a role in the project


1.10   If you are applying as part of a consortium/coalition, please identify the lead
       organisation. Please list all other organisations in the consortium/coalition
       The lead organisation is the one through which all funding would be channelled and who
       would operate as the main point of contact


1.11   If you are applying as part of a consortium/coalition, please state the main objective
       of the group




SECTION 2: INFORMATION ABOUT THE ORGANISATION APPLYING FOR FUNDS
2.1    Organisation name
2.2    Organisation country of residence
2.3    Registration or charity number
       If applicable
2.4    Office address
2.5    Website address
2.6    Main contact person                   Name:
                                             Position:
                                             Email:
                                              1
                                            Tel:
2.7    Which year was the organisation
       established?
2.8    Which of the following best              Non-Governmental Organisation (NGO)
       describes your organisation?             Trade Union
                                                Faith-based Organisation (FBO)
       Select a maximum of two categories       Disabled Peoples’ Organisation (DPO)
                                                Organisations working with Disabled People
                                                Academic Institution / Think Tank
                                                Ethnic Minority Group or Organisation
                                                Diaspora Group
                                                Other... [please specify]
2.9    Provide specific examples to demonstrate how your organisation fits with DFID’s
       values and priorities


2.10   Please provide the annual income for organisation in each of the previous 3 years?
       Please provide the average income for this period In GBP sterling
       This should be drawn from audited or approved accounts where available
From (dd/mm/yyyy)     To (dd/mm/yyyy)       Annual Income
                                            £
                                            £
                                            £
Average Income for the 3 year period        £
2.11   What are your main sources of funding? Please state what % of your annual income you
       currently receive from DFID overall and specifically from DFID GPAF




SECTION 3: INFORMATION ABOUT THE PROJECT
3.1    Which of the following Millennium        Eradicate extreme poverty and hunger
       Development Goals is your                Achieve universal primary education
       project contributing?                    Promote gender equality and empower women
       Check all that apply                     Reduce child mortality
                                                Improve maternal health
                                                Combat HIV/AIDS, malaria and other diseases
                                                Ensure environmental sustainability
                                                Develop a global partnership for development
                                                None of the above
3.2    If you selected ‘none of the above’ for 3.1, please explain why?


3.3    Why is this project needed? What problem is it expected to solve?


3.4    What change is this initiative intended to achieve and for whom? What results/
       impact will this project have on the ground?


                                            2
3.5   How will the changes described above be achieved?


3.6   How and where did this initiative originate? Whose idea was it? Who was involved in
      the design of the project? How were the target beneficiaries involved?


3.7   Who will be carrying out the project’s activities? Which organisations/stakeholders
      will undertake which work?


3.8   What lessons have you drawn on from past experience (yours, your partners, or
      other organisations) in putting together this initiative?




SECTION 4: PARTNERSHIPS
4.1   Please explain the added value that you, the applicant, will bring to this initiative
      beyond accessing funds for the project


4.2   Please describe the nature and length of your relationship with the main partner(s)
      with whom you will be working on this initiative


4.3   Please provide details on your partners’ capacity to undertake this project. What
      previous experience do they have of similar initiatives?




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