"APPLICATION FORM FOR JAPAN'S GRANT ASSISTANCE FOR GRASSROOTS HUMAN"
APPLICATION FORM FOR JAPAN’S GRANT ASSISTANCE FOR GRASSROOTS HUMAN SECURITY PROJECTS PROJECT TITLE : (both in English and Turkish) Date of Application : PART 1 – APPLICANT Name : Address : Tel : Fax : E-Mail : Web-Page (if exists): Responsible Individual : Date of Establishment : Organizational Info : (No of personnel and/or members, objective, activities, budget, etc.) Please attach brochure or booklet describing your organization Past Experience & Projects : (In addition to reference experience and projects, please indicate also and give brief information on any financial/technical assistance received from foreign governments, international organizations or NGOs) 1 PART 2 - PROJECT DETAILS Project Site : (Give a brief description on the location, access conditions and basic demographic information on the local area concerned) Problem Definition / Project : Justification Objective(s) : Detailed Project Activities : (Outline) Organization, Distribution of : Roles and Other Involving Organizations/Parties Output(s) : (List the outputs of the project) Expected Impact : 2 Beneficiaries : (number and brief definition of target group and their present conditions/problems) Risks : (indicate existing or potential risks for the project implementation) Estimated Cost Items : Amount required from GGP : Matching Finance (If Any) : (Who? and How much/Share?) Community/Beneficiary : Contribution and Participation (please indicate the existing and planned participation and contribution of the community/beneficiaries concerned; describe the strategy to ensure the relevant participation and contributions) Environmental Impact : (explain any impact of the project on environment and measures to eliminate any negative impacts) Project Duration : From To (for implementation stage) Project / Application Validity : (please also describe any restriction/ limitation regarding time and season) 3 Sustainability Related : Arrangements (please indicate briefly planned measures regarding operation, maintenance, etc related arrangements to provide sustainability for the project) PART 3 - ATTACHMENTS Please attach the following documents to this form. • Authorization for the responsible individual / project manager • Brochures, booklets, etc. related to the applicant and/or project. • A map showing project site. Date : Name : Title : Signature : 4