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Template - PROGRAM PROPOSAL & FUNDING APPLICATION

INTERNATIONAL DEVELOPMENT PROGRAMS

To ERFA for 2018 CALENDAR YEAR

INSTRUCTIONS Throughout this document, ERFA refers to Edmund Rice Foundation Australia This form is an interactive Word template and must be completed by the Program

Leader We recommend you TAB through this form to ensure all sections are completed but

you may also click to select a field Before completing this form, ensure that you are familiar with ERFA Funding Policy All ERFA Policies are available on ERFA website at www.erf.org.au Please complete all sections of this form A separate budget must be submitted with this application utilising the Budget

Template available under the “Program Toolkit” menu at www.erf.org.au A separate application must be completed for Capital Funding using the Capital

Funding Application template available under the “Program Toolkit” menu at www.erf.org.au

Please email the completed application and attachments to [email protected] prior to 31 August 2017

BACKGROUND INFORMATION FOR APPLICANTSERFA Appraisal of Funding Applications ERFA Funding Application Review Committee undertakes appraisal of Funding Applications under two broad criteria:

Appraisal of Program Design Appraisal of funding applicant’s Capacity to Implement their proposal

Hence, the information requested in this application form is organised under these two criteria.

What is Appraisal? Appraisal is a critical and quality assessment (or evaluation) of a program proposal

against pre-defined criteria The term appraisal is used at the funding application phase to distinguish it from the

evaluation which is conducted at the end of the funding cycle

of 21 Template 1 - Program Proposal & Funding Application V10 301116

mailto:[email protected]

http://www.erf.org.au/



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APPLICATION TEMPLATE CONTENTS

PART 1: PROGRAM DESIGN

A Program DetailsB Program Identification & Design

Vision & Mission Program Background Development Needs Development Objectives Beneficiaries Beneficiary Participation in Program Design Program Plan Program Approvals

C Cross Cutting IssuesD Risk ManagementE Monitoring & EvaluationF WelfareG Complaints Handling

PART 2: CAPACITY TO IMPLEMENT

H GovernanceI StrategyJ Leadership / ManagementK Financial ManagementL SustainabilityM Partnerships & NetworkingN Human ResourcesO Resources & Logistics

PART 3: SUPPLEMENTARY CRITERIA & INFORMATION

P Bank Account DetailsQ Reporting to ERFAR Recognition of ERFAS Authorisation of Funding Application

Supporting Documentation Checklist

Initial Assessment of Application – for ERFA use only


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PART 1: PROGRAM DESIGN

A PROGRAM DETAILS

A1 Program Title FORMTEXT

A2 Program Location / Country FORMTEXT

A3 Governing Authority FORMTEXT

A4 Chair of Governing Authority & Contact Details

Name: Telephone: Email:

A5 Program Manager – Name / Title

FORMTEXT

A6 Program Manager Contact Details

Telephone: Email: Address:

A7.1 New Program - Program Duration How long will the program run for?

Proposed Start Date:

Proposed End Date:

A7.2 Established Program - Duration NA (For established programs it is assumed that funding is for the following calendar year)

A8.1 Total Program Budget for 201_Please specify currency

FORMTEXT

A8.2 Total ERFA Funding RequestedPlease specify currency

FORMTEXT

A8.3 Program Budget Attachments [All Budgets and Budget Forecasts must specify what income is to be dedicated to development activities and what income is to be dedicated to welfare activities (see F1 below for clarification of Welfare)]

Please attach the following: Total Budget (Use online Program Budget

Template)

A8.4 Budget Forecast Please complete the table below. Please specify currency.

Currency Forecast Total Budget Forecast ERFA Funding Required

Explanation of any variation

2018 FORMTEXT FORMTEXT FORMTEXT



A9 Total Cumulative FundingIf ERFA not sole funderPlease specify currency

Donor Funding Amount FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT

A10 Is this program part of an ongoing program? If yes, please provide details.

FORMTEXT


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B PROGRAM IDENTIFICATION & DESIGN

B1 Vision & MissionERFA wishes to confirm consistency between its Vision and Mission and that of funding applicants Please tick ONE of the boxes below regarding your organisation’s Vision and Mission Statements

Our organisation’s Vision & Mission Statements are attached to this application ☐

Our organisation’s Vision & Mission Statements have been provided to ERFA previously ☐

Our organisation does not yet have Vision or Mission Statements ☐

B2 Program BackgroundPlease outline any relevant background to the program e.g. any relevant social, economic and/or cultural factors in the local context FORMTEXT

B3 Statement of Development NeedsWhat is the development issue(s) you are planning to address?Describe the process by which this issue (or these issues) was / were identified and assessed

FORMTEXT

B4 Statement of Development ObjectivesWhat is your main development objective?State any secondary objectives that support the main objective

FORMTEXT

B5 BeneficiariesWho will be the program beneficiaries?

FORMTEXT


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B6 Estimated Total Beneficiaries and Gender / Age ProfilesPlease complete the chart below

Gender / Age Estimated TotalsWomen FORMTEXT Men FORMTEXT Girls FORMTEXT Boys FORMTEXT Women with a disability FORMTEXT Men with a disability FORMTEXT Girls with a disability FORMTEXT Boys with a disability FORMTEXT Estimated Total Beneficiaries FORMTEXT

B7 Beneficiary Participation in Program Design Definition: Program Design involves the identification of communal problems, their causes and consequences and the planning of interventions.

Expectation: ERFA expects programs to be designed in partnership with target communities and evolve from community engagement and participation.

Use the chart below to provide information about how program beneficiaries participated in the identification and assessment of their community’s needs and how they participated in program design

Beneficiaries Type of Participation in Program Design FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT

B8 Program Plan – Overall Strategy What is your overall strategy to achieve your program objective(s)? FORMTEXT


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B9 Program Plan – Outputs, Outcomes & Implementation TimelinePlease complete the table below detailing your planned program outputs and describe the expected outcomes for the target beneficiaries.

Please include the implementation timeline for the planned outputs.

An example is provided here for a Healthy Communities Program in a developing country rural context:

Outputs Implementation Timeline OutcomesSelect & train 12 Community Water Workers to dig and cover wells and maintain and repair hand pumps

February - April Improved access to & use of safe water & decreased incidence of waterborne diseases

Train existing Community Health Workers (CHWs) to increase their knowledge of waterborne diseases & good hygiene practices

February CHWs upskilled & knowledge base increased enabling improved promotion & monitoring of community health

CHWs to conduct community workshops in good hygiene practices

March - May Raised community awareness & use of good hygiene practices & improved community health

Outputs(Planned activities through

which outcomes will be achieved)

Implementation Timeline Outcomes(Predicted impacts for target

beneficiaries)

FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT

B10 Program ApprovalsPlease list below any approvals required for undertaking this program and identify the relevant authority (e.g. civic, education, health, church, governing authority) and indicate if the approval has been obtained

Please attach copies of all approvals


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Program Approvals

Approval Approving Authority Approval Obtained FORMTEXT FORMTEXT YES ☐ NO ☐ FORMTEXT FORMTEXT YES ☐ NO ☐ FORMTEXT FORMTEXT YES ☐ NO ☐ FORMTEXT FORMTEXT YES ☐ NO ☐ FORMTEXT FORMTEXT YES ☐ NO ☐ FORMTEXT FORMTEXT YES ☐ NO ☐ FORMTEXT FORMTEXT YES ☐ NO ☐

B11 ERFA Design, Monitoring & Evaluation PolicyIs your program leadership familiar with ERFA’s Design, Monitoring & Evaluation Policy?

YES ☐ NO ☐

C CROSS CUTTING ISSUES

C Cross Cutting IssuesCross Cutting Issues are integral to development and have strong impacts on development

For each of the 5 Cross Cutting Issues below: name any relevant program site policy which addresses the cross cutting issue outline your planned initiatives to integrate the cross cutting issue into your program

C1 Child Protection

Relevant Policy:Please attach a copy of your Child Protection PolicyName of Program on-site Child Protection Officer: Planned Integration Initiatives: FORMTEXT

C2 Gender Equality & Female Empowerment

Relevant Policy: Planned Integration Initiatives: FORMTEXT

C3 Disability & Inclusiveness



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C4 Protection of Human Rights


C5 Environmental Sustainability(Areas to consider with potential for negative environmental impact: flora & fauna, waterways, waste disposal, energy use, noise, pedestrian & vehicular traffic flows)


C6 Cross Cutting Issues – Professional DevelopmentIn the box below, provide information on any planned staff professional development in cross cutting issues

Planned PD Participants Planned Date(s) FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT

C7 ERFA Cross Cutting PoliciesIs your program leadership familiar with ERFA’s Cross Cutting Policies?

Child Protection Policy & ProcedureGender Equality & Female Empowerment PolicyDiversity & Inclusiveness PolicySustainable Development Policy

YES ☐ NO ☐YES ☐ NO ☐YES ☐ NO ☐YES ☐ NO ☐

D RISK MANAGEMENT


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D1 Risk Management FrameworkPlease complete the Risk Management Framework below or attach your program’s Risk Management Framework.

Are you attaching a Risk management framework? YES ☐ NO ☐

A Risk Management Framework must be submitted for a program to be eligible for ERFA funding

Risk treatmentLikelihood: Unlikely, Possible, Likely, Almost CertainImpact: Insignificant, Minor, Moderate, Major, Extreme [Impact = consequences for project if risk occurs]Identification of potential risks should take into consideration the specific nature of the program

Risk categories offered for consideration Unpredictable in-country

environment: e.g. political, legal, civil unrest, variable exchange rate

Budget forecasts inaccurate

Corruption / fraud

Child protection breach Human rights violation Environmental degradation Implementation schedule

disrupted Program outputs below

quality Stakeholder conflict and / or

disengagement

Authority and / or communication issues – leadership / staff / stakeholders

Staff instability / turnover

Resource shortfall

Risk Management Framework

Risk Description Likelihood Impact Mitigation Strategies FORMTEXT select selec

tselectselect FORMTEXT

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D2 ERFA Risk Mitigation PoliciesIs your program leadership familiar with ERFA’s Risk Mitigation Policies?

Anti-Corruption & Anti-Fraud PolicyCounter Terrorism PolicySafety & Security Policy

YES ☐ NO ☐YES ☐ NO ☐YES ☐ NO ☐

E MONITORING & EVALUATION

E1 Program Site Monitoring Plan

Complete the table below

Aim: systematic collection & analysis of information for management control & decision making

Monitoring: focuses on activities / outputs (i.e. implementation progress – see B9 above)

An illustration is provided here building on the Program Plan – Outputs & Outcomes example in B9 above:

Outputs Quantitative Indicators Data Collection Methods Frequency Responsibility

Select & train 12 Community Water Workers to dig and cover wells and maintain and repair hand pumps

Number of new wells completed & functioning

Number & frequency of maintenance carried out on completed wells

Number of new wells certified by District Water AuthorityWells Maintenance Log

Bi-monthly

End of every month

Wells Construction & Maintenance Co-ordinatorAs above

Train existing Community Health Workers (CHWs) to increase their knowledge of waterborne diseases & good hygiene practices

Number of training sessions conducted

Number of attendees

Number of CHWs who successfully completed training

Training Program Content

Training Program Plan

Attendance Register

Training Certification Register

Review of Training Program Plan

End of training course

Bi-weekly



Community Health Co-ordinator (CHC)

As above

CHC & Program Leader

As above

CHWs conduct community workshops in good hygiene practices

Number of workshops conducted

Number of participants

Workshop content

Workshop Schedule

Attendance register

Review of Workshop Plan

Monthly

Monthly

Monthly


CHC


Program Site Monitoring Plan


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Outputs(see B9 above)

Quantitative Indicators

(e.g. date of completion or specific measure)

Data Collection Methods

(e.g. survey, records, statements)

Frequency Responsibility

FORMTEXT

FORMTEXT FORMTEXT FORMTEXT

FORMTEXT

FORMTEXT


FORMTEXT

FORMTEXT


FORMTEXT

FORMTEXT


FORMTEXT

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FORMTEXT

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FORMTEXT

FORMTEXT


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FORMTEXT


FORMTEXT

FORMTEXT


FORMTEXT

FORMTEXT


FORMTEXT

E2 Program Site Evaluation Plan

Complete the table below

Aim: systematic collection & analysis of information for management control & decision making

Evaluation: focuses on outcomes / impacts (i.e. progress in achieving objective(s) – see B9 above)

An illustration is provided here building on the Program Plan – Outputs & Outcomes example in B9 above:

Outcomes Qualitative Indicators Data Collection Methods Frequency Responsibility

Improved access to & use of safe water & decreased incidence of waterborne diseases

Improved access to safe water

Improved water quality

Reduced morbidity & mortality due to waterborne diseases

District Water Authority Certification Register of new wells & water quality testing records

Community Medical Clinic records

Every 6 months

Every 6 months

Wells Construction & Maintenance Co-ordinator

Community Health Co-ordinator (CHC)

Community Health Workers (CHWs) upskilled & knowledge base increased enabling improved promotion & monitoring of community health

Number of CHWs who have successfully completed training

CHC evaluations of CHW conducted community workshops in good hygiene practices

Program Training Certification Register

CHC & Program Leader observation of community workshops

At end of training courses

Minimum of 2 workshops observed per month

CHC


Raised community awareness & use of

% increase in number of households using safe

Household Surveys Quarterly CHC


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good hygiene practices & improved community health

water supplies

Program Site Evaluation Plan

Outcomes(see B9 above)

Qualitative Indicators(e.g. survey, participation

rates, impacts)

Data Collection Methods

Frequency Responsibility

FORMTEXT


FORMTEXT

FORMTEXT


FORMTEXT

FORMTEXT


FORMTEXT

FORMTEXT


FORMTEXT

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FORMTEXT

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FORMTEXT

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FORMTEXT

FORMTEXT


FORMTEXT

F WELFARE

F1 WelfarePlease respond to each of the questions in the chart below

Note: the inclusion of welfare activities in your program does not automatically disqualify your program from ERFA funding

Welfare ActivitiesDoes your program include:

Provision of direct assistance to individuals? Provision of food, clothing, materials such as

scholarships, school fees, books etc.? Institutionalised care such as orphanages or hospital

care? Giving funds directly to children or families?

YES ☐ NO ☐YES ☐ NO ☐

YES ☐ NO ☐

YES ☐ NO ☐

Do you intend to utilize any ERFA funding for welfare activities? YES ☐ NO ☐


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If you answered YES to the previous question, describe how these activities are necessary for the achievement of your program’s development objectives (stated in Section B4 above) FORMTEXT

F2 ERFA Non Development Activity PolicyIs your program leadership familiar with ERFA’s Non Development Activity Policy?

YES ☐ NO ☐

G COMPLAINTS HANDLING

G1 Complaints HandlingProgram site Complaints Handling Policy & Procedures

Does your Program have a Complaints Handling Policy in place? YES ☐ NO ☐

Are your complaints handling procedures visible for all associated with the program in both English and the local language? YES ☐ NO ☐

G2 ERFA Complaints Handling Policy

Is your program leadership familiar with ERFA’s Complaints Handling Policy YES ☐ NO ☐

PART 2: CAPACITY TO IMPLEMENT

H GOVERNANCE

H1 Governance StructurePlease provide a description of your program’s governance structure. Include the following:

Identity & legal status of governing authority Governance structure – e.g. board or equivalent

Please attach a copy of your governing authority’s governing instrument (e.g. constitution) FORMTEXT

H2 Governing BodyIn the table below, please provide the names and positions of all members of your program’s governing body (i.e. board or equivalent)

Governing Body positions to include: Chair, Deputy Chair, Secretary, Treasurer, Board Member or Director


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Name Position

I STRATEGY

I1 StrategyPlease respond to the questions below regarding your organisation’s strategic planningPlease attach a copy of your organisation’s Strategic Plan or strategy document, unless the most recent edition has been provided to ERFA previously

Does the program for which you are requesting funding form part of an overall Strategic Plan or strategy document?

YES ☐ NO ☐

Has the most recent edition of your organisation’s Strategic Plan or strategy document been provided to ERFA previously?

YES ☐ NO ☐

If you answered NO to the previous question:Is a copy of the most recent edition of your organisation’s Strategic Plan or strategy document attached to this application?

YES ☐ NO ☐ N/A ☐

J LEADERSHIP / MANAGEMENT

J1 Leadership / ManagementPlease describe the leadership and management structure and systems in place for the delivery of your programYour leadership and management structures and systems should be appropriate for the size and scope of your program

K FINANCIAL MANAGEMENT


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K Financial ManagementPlease respond to the questions below regarding the internal financial management system(s) in place for your program

The financial management system should be appropriate for the size and scope of your program

K1 Is your program utilizing the Edmund Rice Development – Edmund Rice Foundation Australia Mission Finance Manual’s systems and procedures for your program’s financial management?

YES ☐ NO ☐

K2 If you answered NO to J1 above, please provide details of your program’s internal financial management systems and procedures. You should include:

Budget preparation system Segregation of duties and authorisation and signature requirements for transaction

approvals Financial documentation and record keeping Cashbook system Banking arrangements Monthly processes

K3 Please indicate the arrangements in place for annual, external, independent audit of your program’s accounts

K4 In the table below, please identify the person(s) responsible for your program’s financial management and their position(s) and responsibilities

Staff Member (full name) Position & Responsibilities

L SUSTAINABILITY

L1 Sustainability Plan – Program OutcomesProvide information on how planned program outcomes will be sustained past the program lifetime and how the target community will be able to sustain the program outcomes beyond that lifetime


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L2 Sustainability Plan - FundingProvide information on any potential alternative funding sources that have been identified, especially any potential in-country sources

M PARTNERSHIPS & NETWORKING

M1 PartnershipsAre you working in partnership with other NGOs, civic or private sector entities? If yes, please provide details of these partners and their roles and responsibilities

M2 NetworkingAre you aware of other programs (NGOs) with similar objectives, outputs and outcomes in your area? If so, are you collaborating with them? If so, how?

N HUMAN RESOURCES

N1 Program / Staff Handbook / Manual

Does your program have a program or staff handbook or manual? YES ☐ NO ☐If YES, please attach a copy of your Handbook / Manual

N2 Policies for Protection of Program Participants, Staff & VolunteersPlease list below any program site policies for the protection of program participants, staff & volunteers and attach copies with your application


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N3 Staffing - Key Program PersonnelIn the table below, please identify the program personnel responsible for program delivery and their positions and responsibilities

Key Program Personnel (full name) Position & Responsibilities

O RESOURCES & LOGISTICS

O1 Program Resources & LogisticsIn the table below, please list essential resources needing to be acquired to implement your program e.g. venue / site, basic equipment, supplies, storage, IT, security systems / transport

New Resources Needing to be Acquired

PART 3: SUPLEMENTARY CRITERIA & INFORMATION

P BANK ACCOUNT DETAILS

P1 Bank Account DetailsPlease provide, in the chart below, details of the bank account approved by your program’s governing authority for receipt of ERFA funding

Account Name Bank name of 21 Template 1 - Program Proposal & Funding Application V10 301116

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Bank Address BSB

Account number Swift Code or IBAN

Q REPORTING TO ERFA

Q1 Reporting to ERFA

Reports and acquittals are vital for the Edmund Rice Foundation (Australia) (ERFA) to understand the funded program, and for the Directors in their exercise of due diligence. Directors are unable to agree to transfers of funds unless the previous Quarterly report has been completed in full, received by ERFA and assessed as compliant.

ERFA requires: Quarterly Monitoring Reports with Statement of Income and Expenditure for the Quarter Annual Acquittal with Independently Audited Financial Report and Management Letter

The Quarterly Monitoring Reports and Annual Acquittal to be provided utilizing the online templates provided on ERFA website

ERFA Monitoring & Evaluation Working group will provide feedback on Quarterly Monitoring Reports and Acquittals, which may include requests for clarification, further information or recommendations for program improvements. ERFA reserves the right to withhold the following round of funding if requests for clarification / recommendations have not been provided or addressed in the subsequent report.

ERFA expects that programs will provide information, as requested, to assist ERFA with reporting program progress to donors and supporters and in the preparation of marketing and fundraising materials

Program leadership is aware of and accepts ERFA reporting and information requirements

YES ☐ NO ☐

R RECOGNITION OF ERFA

R1 Recognition of ERFAERFA expects that due recognition of it will be given by recipients of funding in forums such as annual reports, newsletters, websites and social media

Please indicate in the box below how you intend to acknowledge publicly, ERFA funding support

S AUTHORISATION OF PROGRAM PROPOSAL / FUNDING APPLICATION


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Name:

Position:

Date:

SUPPORTING DOCUMENTATION CHECKLIST

Use this checklist to ensure that all supporting documentation has been attached

Please indicate in the appropriate column on the right whether the most recent edition of documents are attached or have already been provided to ERFA or are not applicable

Documentation Attached Provided to ERFA

Previously

Not Applicable

Budget Template ☐ ☐

Vision & Mission Statements ☐ ☐

Relevant Approvals – see B10 above ☐ ☐

Child Protection Policy ☐ ☐


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Program Risk Management Framework ☐ ☐

Governing Authority Governing Instrument

☐ ☐ ☐

Strategic Plan or Strategic Document ☐ ☐ ☐

Staff or Program Handbook or Manual ☐ ☐ ☐Participant, Staff & Volunteer Policies ☐ ☐ ☐

Please list below relevant additional supporting documentation attached or already provided to ERFA

Click here to enter text. ☐ ☐





INITIAL ASSESSMENT OF APPLICATION – for ERFA use only

Criteria Explanation Provided

Application Clear application & required information providedBudget provided3 Year Budget Forecast providedRisk Management Framework provided

YES / NOYES / NOYES / NOYES / NO

Approvals Approval given by program governing authorityOther approvals to undertake program attached

YES / NOYES / NO

Accountability Previous grants from ERFA fully acquitted and audited(if applicable)

YES / NO / NA

Quantum Consistent with previous operational needs(if applicable)

YES / NO / NA


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Compliance All required program site policies in place YES / NO

Eligibility Program adheres to best practice development principles YES / NO

Initial Assessment

Highly Recommended / Recommended / More Information Required / Not recommended

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