Grants Application Form

The American Center U.S. Embassy Dhaka

The American Center at U.S. Embassy DhakaJ Block, Progoti Sharoni

Notun Bazar, Baridhara, Dhaka

T: (88-02) 5566-2802Email: DhakaGrants@state.gov

Web: http://dhaka.usembassy.gov/grants.html

Grant Application Form

The American Center – U.S. Embassy Dhaka

Note: Before completing this application form, please carefully review the Notice of Funding Opportunity (NOFO) to ensure your organization is eligible for funding from The American Center, and that the activities or project you propose are in line with the Center’s funding priorities. The NOFO can be found here.

The deadline for grant applications is May 17, 2015. Please submit proposal narratives in either a Microsoft Word or PDF format, and submit budget requests in Microsoft Excel. Please send completed applications by email to DhakaGrants@state.gov or by post to:

2015 Notice of Funding OpportunityThe American Center at U.S. Embassy, DhakaJ Block, Progoti Sharoni, Notun BazarBaridhara, DhakaTel: (88-02) 5566-2802

Note: Applicants are encouraged to use as much space as needed for their responses and not limit themselves to the space given under each category. If you need more space, please feel free to attach additional pages.

1. Date of Application:

Section A: The Organization

2. Contact Information

a. Name of Applicant Organization:b. Type of Organization

(NGO/Non-Profit/Foundation/Trust/CBO/Educational Institution

c. Name of Head of Organizationd. Postal Address:e. Office Phone Number:

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f. Cell Number:g. Fax:h. Email:i. Organizational Website:j. 2nd Contact Person for Applicant

Organization (name & designation):k. Cell Number:

3. Date of establishment of organization*: * This will be the date of registration in Bangladesh; please attach a copy of your registration certificate. Your organization must be legally registered in Bangladesh for a minimum of six months to be eligible to apply for funding. Applicant organizations are also required to obtain U.S. Government registrations (see Section 7 below).

4. Legal Status:

Are you legally registered in Bangladesh? YesNo

If yes, please attach a copy of your registration certificate(s).

If no, have you applied for registration in Bangladesh? Yes No

5. Details of Ongoing & Completed Projects (donor-funded)

Going back three years, please list your organization’s ongoing and completed projects. Start with the most recent projects and feel free to add rows to the bottom of the table if you need more space. Project Name Donor/

Funding Source

Major Activities Project Duration (From – To)

Total Budget(BDT)

6. Details of previous projects funded by U.S. Embassy Dhaka (for example, The American Center Dhaka, USAID/Bangladesh, etc.)

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Has your organization received a U.S. Government grant before? YesNo

Date of Award

Award Amount (USD) Purpose of Award

7. Details of Registration in U.S. Government Systems

Organizations that apply for assistance from The American Center Dhaka must obtain the required U.S. Government registrations. First, organizations need a Unique Federal Identifier (UFI), which is known as a DUNS Number (Data Universal Number System). After you have received your DUNS Number, please insert it below. Second, applicants must obtain an N-CAGE (NATO Commercial and Government Entity) Code. After you have received your N-CAGE Code, please insert it below. Follow these instructions to register for a DUNS Number and N-CAGE Code online.

Third, register in SAM (System for Award Management), and obtain proof of application. Follow these instructions to register in SAM.

Only two registrations – a DUNS Number and an N-CAGE Code – are required at the time of application. However, all three registrations – DUNS, N-CAGE and SAM – are required before any grant can be awarded.

All registrations are free of charge. Any additional services offered during the registration processes are not necessary and applicants are under no obligation to sign up for them.

To obtain a DUNS Number, go to http://fedgov.dnb.com/webform/newReq.do. N-CAGE registration information is available at https://eportal.nspa.nato.int/AC135Public/scage/CageList.aspx. To register in SAM, visit www.sam.gov.

Please answer the following:

a) Does your organization have a DUNS Number? Yes No

If yes, please provide the number:

b) Does your organization have an N-CAGE Code? Yes No

If yes, please provide the code:

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c) Does your organization have an active registration in SAM?

Yes No In process

If yes, please provide proof of registration (the email confirmation of registration, or snapshot of organizational overview page from SAM).

8. Administrative Requirements

Organizations that are selected for funding must have a bank account that is able to receive U.S. Government (USG) funds. It is preferred that this bank account be for the grantee organization and not be an individual or personal bank account. Grant recipients will be expected to provide periodic bank statements that show how the USG funds are being used.

Does your organization currently have a bank account? Yes No

If yes, who is responsible for your bank account or has access to your bank account?Name(s) & Designation(s):

If no, would your organization be able to open a bank account if it were selected for funding? Yes No

Section B: Proposed Project

Project Title:

Project Cost: How much funding are you requesting from U.S. Embassy Dhaka? (BDT Amount) (USD Amount)

(Note: Rate of Exchange is 79 BDT = 1 USD)

Focus Area/Sectors: Please tick () all relevant box(es). You may check more than one box. Democratic reform and good governance

Entrepreneurship

Human rights, tolerance and non-violence

Environment

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Education (formal or informal) Arts and culture

Priority/Target Populations: Please tick () all relevant box(es). You may check more than one box. Youth Women and Girls

Underrepresented/Underprivileged Groups

Other populations

Please identify:

Project Location:

Division District Sub-District/Upazila

1. Project Summary/Overview:

Please provide a brief summary of your proposal (one paragraph). Be sure to include the overall goals of the project, mentioning who will be involved, what activities will be done, and who will be impacted or benefit. Please provide as much quantifiable information as possible.

2. Project Rationale:

Why is this project needed? Briefly describe the situation or circumstances that have created the need for the proposed project. Proposed projects should be demand-oriented and meet the actual needs of the priority/target population(s).

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3. Project Goals and Objectives

What results will this project achieve? Please describe the project’s goal(s) and objective(s).

Project Goal(s):

Project Objective(s):

4. Proposed Project Beneficiaries

Who will directly benefit from your project? Which types of people/population groups will be targeted for capacity building? State the number of projected beneficiaries and separate them by gender. Note: Categories should indicate specific demographics such as under age 18/over age 18, women, youth, academicians, professionals, or underrepresented/underserved individuals, etc.

Category 1 Category 2 Category 3 Category 4 TotalMale Example: 20

youth under age 18

Female

5. Project Activities & Timeline

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How and when will the grant award be used? First, list your key project activities. Second, provide a clear, step-by-step timeline for your project. Since the grant period covers a maximum of 12 months, all activities must be completed by September 30, 2016.

Note: Project activities and implementation timeline should be presented in a simple chart. Here are two examples:

Activity/MilestoneTimeline in Months

1 2 3 4 5 6 7 8 9 10 11 12Activity A √ √Activity B √ √Activity C √ √ √ √Activity D √ √ √ √ √

(OR)

Activity Proposed start date

Expected completion date

Activity AActivity BActivity CActivity D

6. Details of the Proposed Team for Project Implementation

Please provide information about the staff members who will be responsible for implementing and overseeing the proposed project. Please also attach CVs for these staff members/volunteers, which are not more than two (2) pages each and indicate the person’s relevant skills and experience.

Name Title Proposed Role Total Working Experience with Your Organization

7. Itemized Budget Details of the Proposed Project:

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An itemized budget is an essential component of the grant application and a critical element in determining applicant eligibility. We ask that you carefully read the instructions provided in the attached budget template and submit an itemized budget using the given format. “Lump-sum” budgets that are not broken down into line items, costs per unit, and total costs, etc. will not be considered for funding.

Instructions for Budget Preparation: Applicants are encouraged to “cost-share” through in-kind contributions. If

your organization would like to share some of the project costs, please explain in what form this contribution will be provided (e.g., labor [staff/volunteers] or materials).

If you have – or plan to solicit – private partners to support your project, please describe this in detail. Please also attach any letters of support that detail project contributions from private organizations.

Provide a detailed breakdown of the project activities as mentioned in the project proposal, and provide a separate budget line item for each of your activities.

Applicants may include indirect costs – also known as “overhead” costs – in their budget requests. These costs can be up to 10%. Requests for overhead costs that exceed 10% of the grant request will not be considered for funding.

The American Center assumes that grant applicants will already be in operation, and have adequate staff/volunteers and most of the capacity required to accomplish their project goals and objectives.

In some cases and where justified, project staff salaries and travel, as well as equipment and operating expenses such as vehicle rental and fuel costs, may be permitted as direct project implementation costs.

Budget requests must be in U.S. Dollars with corresponding columns for the equivalent amounts in Bangladesh Taka. The rate of exchange used by U.S. Embassy Dhaka is constant at 79 BDT = 1 USD.

Please provide budget justifications where needed.

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Section C: Frequently Asked Questions

1) Q. Our organization would like to submit supplemental materials with our project proposal. How should we send them?A. Please submit only the requested documents as outlined in Section D, “Application Checklist.” We are not able to accept samples, prototypes, or other supplementary materials as part of your funding request.

2) Q. If our organization applies for a grant of $25,000 and the Grants Review and Selection Committee approves our request, can we expect to receive the full amount?A. No. Being selected for funding does not guarantee that your organization will automatically receive the full amount it requested. Grant awards depend on a number of factors, including the availability of funds. 

3) Q. Our organization has already received a grant from The American Center Dhaka. Can we apply for a grant again this year? A. The American Center gives preference to new applicants, but the Grants Review and Selection Committee will review each project thoroughly, and determine which proposals best meets the goals and priorities of U.S. Embassy Dhaka.

4) Q. Our organization’s funding request does not fall under any of your stated priorities. Can we still apply for a grant?A. The American Center Dhaka does not award grants to projects or activities that fall outside of its funding priorities.

5) Q. I am an individual seeking financial assistance. Am I eligible for a grant?A. No. As stated in the Notice of Funding Opportunity, American Center Dhaka funding is only available to non-governmental organizations, non-profit organizations, foundations, trusts, community-based organizations and educational institutions that are legally registered in Bangladesh.

6) Q. Does our organization need to have a DUNS Number, obtain an N-CAGE Code, and register in SAM before applying for a grant?A. Your organization must obtain a DUNS Number and an N-CAGE before applying for a grant from The American Center Dhaka. If selected for a grant award, your organization will not be able to receive any funding unless and until it acquires SAM registration in addition to a DUNS Number and N-CAGE Code.

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Section D: Applicant Declaration S. No.

Statements Yes

No

1. The organization has or will obtain DUNS, N-CAGE and SAM registrations prior to receiving any grant award.

2. The applicant organization will comply with The American Center Dhaka’s reporting requirements.

3. The organization will fully comply with The American Center Dhaka’s branding/marking and publicity requirements as explained in U.S. Department of State Identity and Marking Standards (available on the U.S. Embassy Dhaka website).

Section E: Application Checklist S. No.

Required Documents & Assurances Yes

No

1. All sections of the application have been completed as instructed.

2. A copy of the organization’s registration certificate is attached.

3. CVs of the proposed project’s team members are attached. 4. A detailed and itemized budget is attached. 5. The applicant organization has indicated the status of its

registration in DUNS, N-CAGE and SAM. 6. The applicant organization has indicated the availability of

a bank account.7. In cases where the applicant organization has undergone

an external organizational evaluation in the last five years, this report has been attached with the application.

8. If the applicant organization has implemented a project funded by U.S. Embassy Dhaka or USAID/Bangladesh, its project completion report has been attached. (In cases of ongoing projects, the most recent progress report is attached.)

9. Letters of Support (where applicable).

To the best of my knowledge, I declare that all of the above information is true and accurate.

Sincerely,

Name: Designation:

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Electronic Signature: (To be signed electronically by the Head of Organization)

Date:

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