Application for CFLI funding Updated by MANIL- August 22, 2012

APPLICATION FOR PROJECT FUNDING BY THE CANADA FUND FOR LOCAL INITIATIVES-PHILIPPINES

I. A)

Project Identification: Project title: ________________________________________________ (Please provide a descriptive title.)

B) Name of Project Proponent: ____________________________________ C) Location of Proposed Project: Barangay: ______________________________ Municipality/City: _____________________________ Province:___________________________________ Region: _____________________________________ D) Contact person: __________________________________ Designation: __________________________________ Address: __________________________________ __________________________________ __________________________________ Phone: __________________________________ Fax: __________________________________ E-mail __________________________________ E) Brief description of the Project Proponent: (i.e., date of establishment of the group, mandate, membership, etc.) ___________________________________________________________________ ___________________________________________________________________

II.

Project description:

A. Brief description of the project: a) Purpose of the project - What is the purpose of the project? b) Expected immediate results What will the project achieve? What changes are directly attributable to the project activities? c) Project timeframe Over what period of time will the project be implemented? d) Key activities of the project

Application for CFLI funding Updated by MANIL- August 22, 2012

What are the main activities of the project or actions to be taken to gain outputs? (in bullet form only) e) Are there any major risks of which you are aware that could affect the successful implementation of the project? How will they be reduced? f) Other features of the project which you consider important g) Describe any possible environmental impacts or benefits the project might have.

B. Origin and Context: Describe the region and community where the project will be implemented and the reason motivating the request for assistance.

C. Beneficiaries and Participants: a) Who will benefit from the project and how will these benefits be realized? (Total number of recipients and number of women/children.) b) Were the beneficiaries involved in the decision to seek funding and the planning and design of the project? If so, how? c) How and to what extent will the beneficiaries participate in the implementation of the project? d) When the project has been completed, how can this project remain sustainable? What will the communitys future participation be when the project has been completed? e) List the names of the members of the local community responsible for submitting this proposal along with their functions and responsibilities. f) List the names and responsibilities of the key individuals to be involved in the implementation of the project. g) How have you considered the differential impact this project will have on women and men, boys and girls in the community? D. Summary Project Budget: Show the proposed budget by type of activity and who would contribute to each activity. A sample format follows:

(Type of activity) Canada Services Training Equipment Construction

(Contribution by :) Recipient(s) Others*

Total

Application for CFLI funding Updated by MANIL- August 22, 2012

Administration expenses Others (specify) Total

* Specify source of, and reason for, other contributions.

E. Resources requested from the Canada Fund: Specify the exact nature of the assistance requested from the Canada Fund: type/kind of services, equipment, products or construction, etc. F. Community resources: Specify the resources that are available from the community itself, other donors, and the government which have been committed to help finance/implement the proposed project. G. Past Experience a) Describe any (relevant) projects already implemented by the community, including the source of funding, the means of execution, and the results. b) Give information on any previous projects supported by the Government of Canada - when was the project funded, for how much, what Program or Department, whether the project was successfully completed.

Prepared by: Name:_______________________ Signature: ___________________ Position: _____________________ Date:________________________ (More than one signature may be given, if desired.)