2016 ONE Africa Award Application
2016 ONE Africa Award Application Please complete each section of the application and attach the required supplemental documents by 23:59 SAST / 21:59 GMT/UTC Friday, December 2nd 2016 according to the submission guidelines. Please send your completed application to:
ONE Silver Stream Office Park 1st Floor, Main Building 10 Muswell Road Bryanston, 2194 Johannesburg South Africa Or via email to: [email protected] Please note: incomplete applications will not be considered
Further information including the award criteria can be found at http://one.org/africaaward
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Section I. Individual/Organizational Information 1.1 Name of Applicant or Organization
1.2 Name of Affiliations and/or Memberships:
1.3 Address:
1.4 City:
1.5 State:
1.6 Country:
1.7 Telephone:
1.8 Web site:
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1.9 What is the primary role of your organization (please check only one box):
Direct Service non-governmental organization Advocacy based non-governmental organization Other (Please explain) 1.10 How did you hear about the ONE Africa Award?
1.11 Annual Operating Budget (USD):
1.12 Composition of Employees based in Africa (% African and % non-African):
1.13 Primary Operating Country Location(s):
1.14 Previously applied for a ONE Award:
Yes
No
1.15 List Current Donors (that have provided contributions to current operating budget):
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1.16 List Former Donors:
1.17 List Previous Awards Received:
2. Primary Contact Person ONE staff may contact your organization with questions about your application. If you are an organization applying for the ONE Africa Award, please provide the following contact details for your organization’s primary point of contact. Name: Title: Mobile : Phone: Email:
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Application Questions Please answer the following questions according to the specifications stated in each. 3.1
Using the check boxes below, please select the primary sector-specific issues that your organization seeks to address. Please select all that apply.
Poverty Zero Hunger Good Health and Well-being Quality Education Gender Equality Clean Water and Sanitation Affordable and Clean Energy Decent Work and Economic Growth Industry, Innovation and Infrastructure Reduced Inequalities Sustainable Cities and Communities Responsible Consumption and Production Climate Action Life Below Water Life on Land Peace, Justice and Strong Institutions Partnerships for the Goals
3.2
Using the check boxes below, please select any secondary issues that your organization seeks to address. Please select all that apply.
Poverty Zero Hunger Good Health and Well-being Quality Education Gender Equality Clean Water and Sanitation Affordable and Clean Energy Decent Work and Economic Growth Industry, Innovation and Infrastructure Reduced Inequalities Sustainable Cities and Communities Responsible Consumption and Production Climate Action 5
Life Below Water Life on Land Peace, Justice and Strong Institutions Partnerships for the Goals 3.3
In 300 words or less, state your organization’s general mission and purpose including a description of the advocacy-based approaches used to implement poverty reduction goals.
3.4
In 300 words or less, describe the target constituency and/or community that your organization serves. Please include the demographics for this group (i.e. women, out of school youth, etc).
3.5
In 300 words or less, state the problem and/or issue that your organization seeks to address.
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3.6
In 300 words or less, describe how your organization raises public awareness and uses advocacy to address this issue and/or problem.
3.7
In 300 words or less, please include a description of an innovative entrepreneurial and sustainable approach that your organization has taken to deliver a service or program to your targeted community or to promote one of the sustainable development goals
3.8
In 300 words or less, provide three concrete examples (results) that demonstrate how your organization has had an impact on the targeted community that you serve within the past year.
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3.9
In 300 words or less, describe any accountability mechanisms used in the delivery of your organization’s project activities or services (i.e. community leadership consultations, score cards and involvement in programs to demonstrate the interventions are relevant to the majority of the poor in the target community and empowers them in a sustainable way) along with any mechanisms to determine the transparency of your operations.
3.10
In 300 words or less, provide three examples of how your organization has partnered with other civil society organizations, the private sector, educational institutions, and/or government agencies. Please include examples of the type of program activities requiring partner coordination and support.
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3.11
Can the work of your organization be easily replicated by other civil society organizations facing similar issues/problems in their locale? If so, how? Please describe in up to 300 words or less.
3.12
In 300 words or less, describe how the 2016 ONE Africa Award will help advance the mission of your organization, support existing project activities and services, and/or support new projects.
3.13
Based on your successes, In 300 words or less, describe any specific projects, initiatives in your community/country or region that have impacted women and girls. This question is optional and only applies if women and girls are part of your target group and can result in up to 5 bonus points in the scoring of your application.
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Section IV. Supplemental Information Please attach the following documents to your application:
1. Your organization’s certificate of registration. 2. Two letters of recommendations placed on letterhead and signed by the endorsers. One of the endorsers must sign the application form. Letters of recommendation should derive from a reputable national or international organization. 3. Your 2015/16 annual budget with a reasonable breakdown of expenses and revenue. 4. The most recent Annual Report for your organization. 5. Copies of media reports, films, photographs or articles highlighting the work of your organization, if available. Please caption and label these. 6. Contact details of three references for your organization, preferably donors, policy targets and beneficiary communities.
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Please sign and print your name below.
____________________ Applicant Signature
____________________ Print Applicant’s Name
____________________ Endorser signature
____________________ Print Endorser’s Name ONE reserves the right to disperse award funds in installments or over time, depending on the operating size of the award recipient. The information outlined in this application has been requested in order to make recommendations to the 2016 ONE Africa Award Selection Committee. Application information and attachments that you have submitted will be distributed to third parties for assessment purposes and post-award reporting. Signatories to this application, therefore, authorize the use by ONE of the information contained for publicity and information sharing purposes and for any other reasons related to ONE’s exempt purposes. The 2016 ONE Africa Award recipients will be selected by ONE at its sole discretion. All decisions are final.
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ONE Silver Stream Office Park 1st Floor, Main Building 10 Muswell Road Bryanston, 2194 Johannesburg South Africa Or via email to: [email protected] Please note: incomplete applications will not be considered
Further information including the award criteria can be found at http://one.org/africaaward
1
Section I. Individual/Organizational Information 1.1 Name of Applicant or Organization
1.2 Name of Affiliations and/or Memberships:
1.3 Address:
1.4 City:
1.5 State:
1.6 Country:
1.7 Telephone:
1.8 Web site:
2
1.9 What is the primary role of your organization (please check only one box):
Direct Service non-governmental organization Advocacy based non-governmental organization Other (Please explain) 1.10 How did you hear about the ONE Africa Award?
1.11 Annual Operating Budget (USD):
1.12 Composition of Employees based in Africa (% African and % non-African):
1.13 Primary Operating Country Location(s):
1.14 Previously applied for a ONE Award:
Yes
No
1.15 List Current Donors (that have provided contributions to current operating budget):
3
1.16 List Former Donors:
1.17 List Previous Awards Received:
2. Primary Contact Person ONE staff may contact your organization with questions about your application. If you are an organization applying for the ONE Africa Award, please provide the following contact details for your organization’s primary point of contact. Name: Title: Mobile : Phone: Email:
4
Application Questions Please answer the following questions according to the specifications stated in each. 3.1
Using the check boxes below, please select the primary sector-specific issues that your organization seeks to address. Please select all that apply.
Poverty Zero Hunger Good Health and Well-being Quality Education Gender Equality Clean Water and Sanitation Affordable and Clean Energy Decent Work and Economic Growth Industry, Innovation and Infrastructure Reduced Inequalities Sustainable Cities and Communities Responsible Consumption and Production Climate Action Life Below Water Life on Land Peace, Justice and Strong Institutions Partnerships for the Goals
3.2
Using the check boxes below, please select any secondary issues that your organization seeks to address. Please select all that apply.
Poverty Zero Hunger Good Health and Well-being Quality Education Gender Equality Clean Water and Sanitation Affordable and Clean Energy Decent Work and Economic Growth Industry, Innovation and Infrastructure Reduced Inequalities Sustainable Cities and Communities Responsible Consumption and Production Climate Action 5
Life Below Water Life on Land Peace, Justice and Strong Institutions Partnerships for the Goals 3.3
In 300 words or less, state your organization’s general mission and purpose including a description of the advocacy-based approaches used to implement poverty reduction goals.
3.4
In 300 words or less, describe the target constituency and/or community that your organization serves. Please include the demographics for this group (i.e. women, out of school youth, etc).
3.5
In 300 words or less, state the problem and/or issue that your organization seeks to address.
6
3.6
In 300 words or less, describe how your organization raises public awareness and uses advocacy to address this issue and/or problem.
3.7
In 300 words or less, please include a description of an innovative entrepreneurial and sustainable approach that your organization has taken to deliver a service or program to your targeted community or to promote one of the sustainable development goals
3.8
In 300 words or less, provide three concrete examples (results) that demonstrate how your organization has had an impact on the targeted community that you serve within the past year.
7
3.9
In 300 words or less, describe any accountability mechanisms used in the delivery of your organization’s project activities or services (i.e. community leadership consultations, score cards and involvement in programs to demonstrate the interventions are relevant to the majority of the poor in the target community and empowers them in a sustainable way) along with any mechanisms to determine the transparency of your operations.
3.10
In 300 words or less, provide three examples of how your organization has partnered with other civil society organizations, the private sector, educational institutions, and/or government agencies. Please include examples of the type of program activities requiring partner coordination and support.
8
3.11
Can the work of your organization be easily replicated by other civil society organizations facing similar issues/problems in their locale? If so, how? Please describe in up to 300 words or less.
3.12
In 300 words or less, describe how the 2016 ONE Africa Award will help advance the mission of your organization, support existing project activities and services, and/or support new projects.
3.13
Based on your successes, In 300 words or less, describe any specific projects, initiatives in your community/country or region that have impacted women and girls. This question is optional and only applies if women and girls are part of your target group and can result in up to 5 bonus points in the scoring of your application.
9
Section IV. Supplemental Information Please attach the following documents to your application:
1. Your organization’s certificate of registration. 2. Two letters of recommendations placed on letterhead and signed by the endorsers. One of the endorsers must sign the application form. Letters of recommendation should derive from a reputable national or international organization. 3. Your 2015/16 annual budget with a reasonable breakdown of expenses and revenue. 4. The most recent Annual Report for your organization. 5. Copies of media reports, films, photographs or articles highlighting the work of your organization, if available. Please caption and label these. 6. Contact details of three references for your organization, preferably donors, policy targets and beneficiary communities.
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Please sign and print your name below.
____________________ Applicant Signature
____________________ Print Applicant’s Name
____________________ Endorser signature
____________________ Print Endorser’s Name ONE reserves the right to disperse award funds in installments or over time, depending on the operating size of the award recipient. The information outlined in this application has been requested in order to make recommendations to the 2016 ONE Africa Award Selection Committee. Application information and attachments that you have submitted will be distributed to third parties for assessment purposes and post-award reporting. Signatories to this application, therefore, authorize the use by ONE of the information contained for publicity and information sharing purposes and for any other reasons related to ONE’s exempt purposes. The 2016 ONE Africa Award recipients will be selected by ONE at its sole discretion. All decisions are final.
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