PISCCA 2017 Application Form .pdf
Nom original: PISCCA-2017-Application-Form.pdf
Titre: Fiche de demande de financement par un bénéficiaire
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AMBASSADE DE FRANCE AU NIGERIA
SERVICE DE COOPERATION ET D’ACTION CULTURELLE
Innovative Projects from Civil Societies and Coalitions of Actors (PISCCA)
Projets Innovants des Sociétés Civiles et des Coalitions d’Acteurs
Deadline to submit proposals: 23th of July 2017
Please read the PISCCA guidelines before filling in this Application Form
This form should not exceed 15 pages and shall be sent along with the
required documents (see the complete list in the guidelines)
1. APPLICANT INFORMATION
Name of the organization
Dates of creation and registration
Address of the organization
Website and social media pages (if any)
Geographical areas of intervention
Sectors of intervention
Presentation of the organization
Present a brief history of the organization, its goals
and mission, number of members, target group, etc.
List the permanent and temporary employees or
volunteer, stating each person’s function.
Describe the kind of resources the organization has
and indicate the overall budget of the organization
for 2016 and 2017.
Brief list of on-going or finished projects
Affiliation (if any)
Head of the organization
For each project, indicate the location, the total cost
and the sources of funding
List any networks or coalitions of CSOs’
Complete contact information (phone number, email
and address) of the head of the organization.
Bank details and references
2. GENERAL INFORMATION OF THE PROJECT
Name of Project
Representative of the
(before end 2018)
Shorter duration encouraged.
3. REFERENCE FRAMEWORK AND
DESCRIPTION OF THE PROJECT
Description of the project.
Describe the environment in which the project would operate. It covers both the internal and
external environment. Different projects have different contextual issues to deal with
therefore is important to understand a project’s context. An inventory of the context may
include the area's natural environment, the area's social environment, the area's economic
environment, the area's cultural characteristics…
3.3 Needs assessment and problem statement:
The needs assessment determines the needs. The discrepancy between the current condition
and wanted condition must be measured to appropriately identify the need.
The problem statement is a brief description of the issues that need to be addressed.
The justification shall explain why your organization needs to implement this particular
solution to this particular problem and how this solution can be implemented.
Mention the elements of information relevant to the project and justify the relevance of your
project regarding the needs assessment. Describe why your project is of ultimate importance
for your community and elucidate the ways in which, by developing this project, you will
consistently achieve your set goals (social or economic improvement through the resolution of
the specific problem).
The justification presents the problem that the project aims at solving. Therefore, it should
specify with concrete details: the current situation, the identified problem, the elements to
address and to resolve the identified problem planed by the Holder of the project.
3.5 Overall objective:
This is the long-term goal of the project, which extends beyond the project’s timeline and
scale of intervention.
3.6 Specific objectives:
They should directly address the identified problems and assessed needs State the specific
objectives of the project.
Provide measurable quantitative indicators for the project’s objectives. These indicators
should allow us to directly measure progress towards achieving the objectives. They must be
Specific, Measurable, Achievable, Relevant and Time-bound (SMART).
3.8 Involvement of the community:
4.1 Description of activities:
Please describe with details every activity that you wish to implement within the project.
Please complete the calendar below by filling in the months of implementation for each main
activity. Add as many lines as needed to have one line per main activity.
Example activity 1
4.3 Implementation mechanism:
Describe who is going to do what.
5. SITUATION AFTER PROJECT COMPLETION
5.1 Expected results:
Decribe the expected results at the end of the project. These are the actual tangible services
provided and the positive changes that will be brought by the project.
Mesure the effects of the project in tackling poverty and/or in strengthening the civil society
(increase of activities, of revenues, satisfaction of basic needs, improvement of living
standards, increase of active and efficient organization, strengthening the capacities of local
5.3 Sustainability of expected effects:
Skills transfer, institutional strengthening, recurrent costs cover, appropriation of changes by
6.1 Total cost of the project:
Indicate the total amount and the total by activities.
6.2 Amount of PISCCA grant (in NGN and EUR) requested:
- In total
- By activity
- By year
6.3 Applicant’s contribution (cash or in-kind):
Briefly detail your contribution to the project’s budget, monetary and/or in kind.
- Amount (in NGN and in Euros)
- Percentage (%)
6.4 Other donors, if any:
If the project has other funding sponsors, please include:
- sponsor’s name and funds contributed;
- the activities that are to be funded by the other donors.
7. IMPLEMENTING PARTNERS (IF ANY)
If the project has implementing partners or is submitted on behalf of a coalition of actors,
please provide for each partner the following elements:
- complete contact details;
- description of the organization (c.f. the “applicant information” section);
- description of the financial and technical role in the implementation of the project.
Add as many lines as partners.
8. MONITORING AND EVALUATION
8.1 Monitoring :
8.2 Evaluation :
9. COMMUNICATION AND VISIBILITY
Describe briefly the communication strategy and the means of ensuring visibility for both the
project itself and the contribution from the French Embassy.
10. COMMITMENT OF THE BENEFICIARY
10.1 The applicant hereby declares that all information on the form is correct and
10.2 If the project is selected, the candidate agrees to implement the project as planned
and to carry out all planned activities as indicated in the application form.