Anda di halaman 1dari 4

Due Date: June 24, 2016

Project Application for Funding by the Canada Fund for Local Initiatives (CFLI)
All text in blue is for assistance in filling out the form. You may delete all blue writing and/or replace
with project proposal information.
1. Descriptive Project Name: Input here
(Example: Strengthening democratic participation of women in Country X elections with
information workshops and a Mock Parliament)
2. Location of Proposed Project: Input here
City/village: Input here
District: Input here
State: Input here
Country: Bosnia and Herzegovina
3. Name of applicant organization/group: Input here
Name of contact person: Input here
Title/function of contact person: Input here
Input here
Input here
Input here
Phone (Office): Input here
Phone (Mobile): Input here
Fax: Input here
E-mail: Input here
Organisation website (if any): Input here
4. Brief description of the applicant organization/group: (i.e. date of establishment of the org/group,
its mandate, who makes up its membership, etc.)
5. Type of organization/group: Please check only one.
Local non-governmental, community and not-for-profit organizations,
Local academic institutions working on local projects,
International, intergovernmental, multilateral and regional institutions, organizations and agencies
working on local development activities,
Municipal, regional or national government institutions or agencies of the recipient country
working on local projects, and
Canadian non-governmental and not-for-profit organizations that are working on local
development activities.
6. Explanation of the project:
What is the purpose of the project?
What are the main activities or actions of the project (in point form only)?

Due Date: June 24, 2016

Over what period of time will the project be implemented? Please provide a detailed month-bymonth implementation plan.
Expected Results
What will the project aim to achieve? (i.e. what are the immediate expected results of the
project?) Please list performance indicators (qualitative and/or quantitative) in point form for
each expected result (i.e. how to demonstrate the desired outcome has been achieved).
Are there any major risks of which you are aware that could affect the successful implementation
of the project? If so, please outline how each will be mitigated?
Environmental Factors
Please describe any possible environmental impacts or benefits the project might have.
Other Comments
If there are other features of the project that you consider important, please include them here (in
point form).
7. CFLI Priority: Please check only one priority
Promoting stability and security;
Championing inclusive and accountable governance, peaceful pluralism and respect for diversity,
and human rights;
Promoting gender equality and empowerment of women and girls;
Addressing climate change and enhancing environmental sustainability;
Stimulating sustainable and green economic growth;
8. Origin and Context:
Briefly describe the region and community where the project will be implemented and the reason
motivating the request for assistance.
9. Beneficiaries and Participants:
Who will benefit from the project and how will these benefits be realized?
o Estimated number of direct recipients:
o Estimated number of women/children beneficiaries:
o Estimated number of (Input here) beneficiaries (in case of other specific groups):
o Estimated number of indirect beneficiaries:
Were the direct beneficiaries involved in the decision to seek funding and the planning and design
of the project? If so, how?
How and to what extent will the beneficiaries participate in the implementation of the project?
When the project has been completed, what will their future participation be?
List the names of the members of the local committee responsible for submitting this proposal
along with their functions and responsibilities.
List the names and responsibilities of the key individuals to be involved in the implementation of
the project.
How have you considered the differential impact this project will have on women and men, boys
and girls in the community?

Due Date: June 24, 2016

10. Summary Project Budget: _________________CAD
Show the proposed budget by type of activity and who would contribute to each activity. A sample format
follows (please provide a detailed breakdown under each budget heading):
Contribution by:

Type of














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

All budget items should be presented in BAM (Convertible Mark), with totals for each line
presented in BAM, EUR (euro) and CAD (Canadian dollar). Projected procurement costs for each
item should be researched locally at the time the budget proposal is drafted.
The budget proposal should be accompanied by a justification/description of each item in
narrative form.
Provision for bank charges should form part of the budget proposal under administration
The budget proposal should include a small reserve, to cover possible currency exchange
fluctuations over the course of the project.
Please note that CFLI funds cannot be used to cover the recurrent or core costs of an

11. Past Experience:

Describe any (relevant) projects already implemented by the community, including the source of
funding, the means of execution, and the results.
Give information on any previous projects supported by the Government of Canada. Please
specify when was the project funded, for how much, what Program or Department, whether the
project was successfully completed.
12. Publicity/Promotion:
Briefly explain how the project would provide visibility for the Government of Canada
Traditional media (print, radio, television)
Briefly explain how the project and will be promoted, including plans to attract media coverage
Social media
Briefly explain how the project and will be promoted, including plans to attract attention
Supporting documentation:
Please attach the following to the application:
Registration document;

Due Date: June 24, 2016

Bank account details (applicant must provide details of a foreign currency bank account to which
funds from abroad may be transferred);
Annual report (if available);
Most recent annual financial statements and expense budgets for the current fiscal year;
Reference letters from other donors/organizations for activities to date.

Proposal Prepared by:

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