Proposal Submission Form Sustainable Economic and Educational Development Society (SEEDS) 12688 NW Naomi Ln, Portland, OR, USA 97229 1. Project Name: 2. Project Location: Town/village(s): District: State: PIN: 3. Project Type (please check all that apply) Integrated Development Social Action Education Farming Techniques Other (specify) 4. Please provide the following information about the person who will serve as the project's director: Name and Title: Organization: Full Address: Information about additional person(s), if any, who will be responsible for coordinating the project: Name and Title: Organization: Full Address: 5. Period for which you are requesting funding and its total amount: Beginning date: D/M/Y Ending date: Amount: Rs. Background 6. Please describe the current physical, social and economic conditions in the project area. 7. If your organization is already working in the project area, please describe its efforts and achievements to date. 8. If, to your knowledge, any development projects similar to the one you are proposing has been carried out within last 10 years, please give the name, its sponsoring organization, its current status, and a brief description of its accomplishments and failures, for each such project. 9. What made you and your organization to undertake the project for which you are now requesting funds? Project Description 10. Please describe the objectives of your project and what you want to accomplish during the grant period? 11. What can you do that other development projects in the area, if any, have not done? 12. Please describe the methods, techniques, and approaches you will use to accomplish your objectives? 13. Who and approximately how many will benefit from your project. What specific benefits can they hope to receive? 14. What do you foresee the project to evolve into after the grant period? Will it become self-sufficient ? Schedule & Progress monitoring 15. To help us understand your project plans, please indicate below the major activities that you hope to undertake during the grant period. Give a brief description of each activity and its plan quarter & year. If you receive a grant from us, we require periodic progress reports and yearly audit report for the project. On-site monitoring may be arranged according to mutual con- venience. Example: Funding year 1993: Quarter 1: Begin construction of the tube well Quarter 2: Conduct health camp, get more women & men involved Quarter 3: Training for new farming technique. Quarter 4: Finish well 19__ Funding Year 1 Quarter 1: Quarter 2: Quarter 3: Quarter 4: 16. If you plan to request funding for more than one year, please indicate the major activities you hope to undertake in year 2 and year 3 (if applicable). Please note: If this application is accepted, your project will be guaranteed funds for only one year. Funding for addi- tional years will be contingent on your project's performance and our financial resources. Funding Year 2: From________________ through ____________________ Funding Year 3: From________________ through ____________________ Funding 17. List major funding sources for your organization during last 5 years: Please indicate funding agency's Name , Address & Affiliation where possible. (Affiliation: Political Party, Social Action Group, Gandhian/Sarvodaya , or Other (explain)) 18. If work on this project for which you are requesting fund is underway, please list below the name and the address of each agency that provided funding and the grant received: Funding Agency's Name Address Grant Amount Grant Period 19. Does your organization have official Government of India permission to receive foreign funds? a. If yes, please enclose a copy of the permission form with this application. b. If no, has your organization applied for this permission? Yes. Date of Application? No. What mechanism do you propose for us to transmit funds to you? Budget 20. Below please provide detailed information on the ways in which you intend to use the funds that you are requesting form us. Please remember that you r project will be evaluated every year for grant of funds after initial acceptance. Funding Year 1: __________________ through ___________________ Purpose of Expenditure Expenditure Amount Total expenditures --- Funding Year 1 Rs._____________ Funding Year 2 (if applicable): __________________ through ___________________ Purpose of Expenditure Expenditure Amount Total expenditures --- Funding Year 2 Rs._______________ Funding Year 3 (if applicable): __________________ through ___________________ Purpose of Expenditure Expenditure Amount Total expenditures --- Funding Year 3 Rs._______________ Grand Total --- Funding Years 1-3 Rs._______________ Bibliographies (More About You) 21. With this application form please enclose bibliographical materials on the project director and project coordinators whose names are given on page 1. These materials should include information on the educational qualification and work ex- perience of these individuals, as well as their past activities and accomplishments in the field of development. 22. Please also submit information on the organization that will be undertaking the project described in this application. This material should explain the organization's basic philosophy and aims and should include a list of its board of directors and their affiliations. I certify that the information provided in this application is true and complete to the best of my knowledge. I also certify that if I and the organization I am authorized to represent should receive a grant from SEEDS we will abide by the terms and conditions of that grant as established by SEEDS. I further certify that all grant monies from SEEDS will be used exclusively for the purposes stated in this application unless I formally request and receive prior authorization from SEEDS for any changes. (Signed)_______________________________ Date:_________________________ Copyright 1995-2007 SEEDS. All Rights Reserved. info@seedsnet.org