Canada Fund for Local Initiatives (CFLI) Project Application for Funding Form 

A)   APPLICANT INFORMATION

1.     Descriptive Project Name:

2.       Location of Proposed Project (City/village, District/State, Country/Territory):

3.     Name of applicant organization/group:

Contact Person

Name/Title:

Address:

Phone/Fax:

E-mail: 

Applicant website, Facebook, and Twitter account (if available):

4.      Please provide details on the legal status of the applicant organization/institution in the country of operation. Please include proof of your legal status when submitting the application for funding (e.g. scanned copy of registration).

Is local government authorization/approval required for implementation of planned activities?

                        ☐ Yes

☒  No

If yes, please explain.

5.     Brief description of the applicant organization/group: (Maximum 150 words)

6.     Past Experience:

Have you previously received funding from the Canada Fund for Local Initiatives (CFLI) or other Government of Canada programs? If yes, please indicate the year, brief project description and amount received.

Has your organization or group implemented any other relevant projects? If yes, please indicate the year, brief project description, amount received and the source of funding.

7.                Type of organization/group:☐  Local, national or community-based organization (non-governmental and not-for-profit)

☒  Local municipal, regional or national government institution or agency of the recipient country

☐  Local academic institution

☐  Canadian organization (non-governmental or not-for-profit) that is working on local development activities

☐  International or regional organization (non-governmental or not-for-profit) that is working on local development activities

☐  Intergovernmental or multilateral institution, organization or agency working on local development activities

8.     Women’s rights organization: Note: this information is gathered for statistical purposes only and will not affect your eligibility for funding.

Are you a civil society organization active at the grassroots, national, regional or international level, with a primary focuson gender equality and women/girls’ rights advanced through a variety of activities, including advocacy and policy dialogue, awareness-raising, service provision, research, and networking?

☐  Yes

☒  No

9.     Human Rights/ Inclusive Governance organization: Note: this information is gathered for statistical purposes only and will not affect your eligibility for funding.

Are you a civil society organization active at the grassroots, national, regional or international level, that advocate for the promotion and protection of human rights, equitable access to a functioning justice system, enhanced participation in public life, and/or public services that work for everyone?

☒  Yes

☐  No

B)  PROJECT NARRATIVE:

1.     Context:

Describe the region and community where the project will be implemented. (Maximum 150 words)

What is the primary issue (problem) this project is seeking to address? (Maximum 150 words)

2.      Explanation of the project:

What is the goal of the project and what are the expected long-term results? (Maximum 300 words)

What are the main project activities and the immediate expected results? Please, complete the table below:

Describe any possible effects (positive or negative) the project may have on the natural environment. (Maximum 150 words)

3.   Advocacy Plan:

Describe your advocacy plan for the project. How are you going to raise awareness about your project, including Canada’s contribution, using traditional and social media? Please complete the table below:

4.   Thematic Priority: Please check one thematic priority only.

☐ Gender equality and the empowerment of women and girls

☐ Inclusive governance, including diversity, democracy, human rights and the rule of law

☒ Human dignity, covering health, education and nutrition

☐ Environment and climate action focusing on adaptation and mitigation, as well as on water management

5.    Sub-theme:Please check one sub-themethat further describes your project. Note: Gender Equality and the Empowerment of Women and Girls should NOT be selected as a sub-theme if already selected as the Thematic Priority.

6.    Beneficiaries and Participants: Note: Fund recipients will be required to track age and gender-disaggregated beneficiary data (e.g.: number of women/girls over and under 18 years of age; number of men/boys over and under 18 years of age).

Государственное учреждение образования «Средняя школа д. Вистычи», в лице директора школы

Who (men, boys, women, girls, civil society organizations, journalists etc.) will benefit from the project and where are they located?

Were anticipated project beneficiaries consulted on the project design?

            ☐ Yes

            ☒ No

Please explain. (Maximum 150 words)

Will project beneficiaries continue to be engaged on the issue after the completion of the project?  

☒ Yes

            ☐ No

Please explain. (Maximum 150 words)

7.     Gender-Based Analysis (GBA): Note: inadequate completion of this section may affect the consideration of your project. Ensure that all questions are addressed in a detailed and meaningful way. You may wish to consult the Applicant’s Guide for completing a GBA (available from the Canadian Embassy).

Gender equality means that diverse groups of women, men, girls and boys, and gender-diverse people are able to participate and contribute to all spheres of life. Canada’s feminist approach to foreign policy requires that our international assistance be informed by a gender-based analysis that includes evidence of meaningful consultations with women and/or girls before a project begins. Canada’s approach also recognizes that other aspects of identity such as religion, race, and socio-economic class, may contribute to how individuals experience the problem the project is seeking to address.    

Gender-based analysis examines the potential impacts of projects on diverse groups of women and men, girls and boys.  It identifies the varied roles played by women and men, girls and boys in the household, community, workplace, political process, and economy.  These different roles usually result in women having less control and access to resources and decision making processes than men.     

How are women, men, boys and girls affected differently by the problem your project is seeking to address? (Maximum 150 words)

How do other identities (religion, sexuality, age, ethnicity, socio-economic class etc.) of women, men, boys, and girls play into their experiences of the problem? (Maximum 150 words)

Were women and/or girls consulted on the project design? Note: consultations can include, but are not limited to: speaking to women and/or girls from the local community; speaking to women and other individuals who work for civil society organizations that have worked in the local community; speaking to female and male decision and change-makers who have knowledge of the local community.

☒ Yes

☐  No

Please explain. (Maximum 150 words)

How have the findings from your gender-based analysis shaped the project design? (Maximum 150 words)

8.      Risk Matrix: (Please fill out the following table)

Please consult Annex B for the definition of terms contained in the risk matrix.

9.     Monitoring and Evaluation of Project:

How will the organization measure outcomes? Does the proposed budget account for the monitoring and evaluation of the proposed project? (Maximum 150 words)

10.   Simplified Project Budget: CAD 

Does Canada’s contribution represent the whole of the project’s expenses?

☒ YES, Canada’s contribution is intended to cover all project expenses.

☐ NO, applicant will receive other funding and/or provide in-kind contribution.

Note: An “in-kind contribution” represents a non-monetary contribution (e.g. goods or services).

Please specify the source(s) of other funding (e.g. local government, foundation, etc.):

Does this project span one (1) or two (2) years?

                        ☒ 1 year

                        ☐ 2 years

Please outline the proposed budget by activity type, indicating all possible funding sources per activity. Note: if the proposed project is selected for further consideration, a more detailed budget will be requested.

Please consult Annexe C for budget examples.

ONE YEAR PROJECT 

TWO YEAR PROJECT

11.  Do you have an organizational bank account? Where is the bank located? (Please note that we cannot transfer the contribution to individual bank accounts or handle cash).

……Да, есть.………………………………………………………………………………….

12.  If shortlisted, you will have to add the following information:

-         Who will be the person signing the Contribution Agreement

Криштапович Наталья Викторовна, директор школы

-         Who will be the project manager, and working contact with the CFLI Coordinator

Криштапович Наталья Викторовна, директор школы

-         Who will be your contact dealing with project budget / accountant

-         Криштапович Наталья Викторовна, директор школы

-         Would somebody from your organization be available for a meeting in Warsaw.

ДА

Proposal Prepared by: (More than one name may be given, if desired.)

Name:  Криштапович Наталья Викторовна

……………………………………….

Position/Title: …директор школы…………………………….

E-mail address: …nkrishtapovich@mail.ru…………………………

Date (yyyy-mm-dd): ……17/08/2031………………

Annex A

Eligible Costs 

The following expenses within projects are eligible for CFLI funding:

●      accounting costs,

●      administrative and overhead costs related to the project (overhead should not exceed 15% of total CFLI contribution),

●       advocacy and lobbying related costs,

●       capital and/or operating expenditures related to the lease and/or purchase and/or building of infrastructure,

●       civic education costs,

●       conference and event expenditures,

●       costs of services received by recipients,

●       domestic travel expenses (using low fares),

●       environmental assessment costs,

●       facilities and equipment rental charges,

●       hospitality costs, excluding alcoholic beverages,

●       installation, maintenance, shipping and/or transportation costs, including fuel, computers and communication devices,

●       lease or rental of vehicles,

●       legal costs,

●       medical costs,

●      miscellaneous expenses integral to the project,

●       outreach, communication and information dissemination costs,

●       publishing costs,

●       radio and television broadcast fees,

●       research-related costs,

●       salary costs relating to the project,

●       security costs,

●       training and capacity building expenditures,

●       translation and interpretation fees,

●       vehicle and equipment operation, installation and/or maintenance,

●       website development and related costs.

The following expenses within projects are NOTeligible for CFLI funding:

●       assistance to military or paramilitary organizations,

●       direct fiscal support to a government,

●       core funding.

●       expenses incurred prior to the signing of the CA, or after it expires,

●       nuclear technologies and facilities,

●       gifts,

●       luxury goods,

Annex B

Risk Assessment

*Risk Categories

1) External: Potential risks related to socio-economic or political circumstances beyond the control of the implementing entity. For example: civil war or political instability, systemic gender discrimination, lack of infrastructure.

2) Financial: Potential risks related to funding, misuse/mismanagement of funds or fraud. For example, currency fluctuations which reduce the amount of funding available for the project in the local currency. 

3) Operational: Potential risks related to the internal capacity of the implementing entity. For example, not having sufficient staff with the right skills to carry out the project.

 4) Safety and Security: Potential risks related to the safety and security of the recipient or beneficiaries by implement this project. For example: state surveillance, hostile environment for human rights defenders.

5) Timeframe: Potential risks related to delays in the implementation of the project affecting the achievement of outcomes.  For example: regulatory delays, seasonal delays (e.g. rainy season).

**Likelihood Categories

High Likelihood: Risk is very probable/certain.

Medium Likelihood: There is a probable chance that the risk will manifest. 

Low Likelihood: There is a remote to improbable chance that the risk will manifest.

Annex  

Budget Example 

ONE FISCAL YEAR 

TWO FISCAL YEAR 

 Canada Fund for Local Initiatives (CFLI) Project Application for Funding Form  

A)   APPLICANT INFORMATION

1.     Descriptive Project Name:

2.       Location of Proposed Project (City/village, District/State, Country/Territory):

3.     Name of applicant organization/group:

Contact Person

Name/Title: 

Proposal Prepared by: (More than one name may be given, if desired.)

Name:  Natalia Krishtapovich……………………………………….

……………………………………….

Position/Title: … headmaster…………………………….

…………………………….

E-mail address: …nkrishtapovich@mail.ru…………………………

Date (yyyy-mm-dd): ……17/08/2023………………

Annex A

Eligible Costs 

The following expenses within projects are eligible for CFLI funding:

●      accounting costs,

●      administrative and overhead costs related to the project (overhead should not exceed 15% of total CFLI contribution),

●       advocacy and lobbying related costs,

●       capital and/or operating expenditures related to the lease and/or purchase and/or building of infrastructure,

●       civic education costs,

●       conference and event expenditures,

●       costs of services received by recipients,

●       domestic travel expenses (using low fares),

●       environmental assessment costs,

●       facilities and equipment rental charges,

●       hospitality costs, excluding alcoholic beverages,

●       installation, maintenance, shipping and/or transportation costs, including fuel, computers and communication devices,

●       lease or rental of vehicles,

●       legal costs,

●       medical costs,

●      miscellaneous expenses integral to the project,

●       outreach, communication and information dissemination costs,

●       publishing costs,

●       radio and television broadcast fees,

●       research-related costs,

●       salary costs relating to the project,

●       security costs,

●       training and capacity building expenditures,

●       translation and interpretation fees,

●       vehicle and equipment operation, installation and/or maintenance,

●       website development and related costs.

The following expenses within projects are NOTeligible for CFLI funding:

●       assistance to military or paramilitary organizations,

●       direct fiscal support to a government,

●       core funding.

●       expenses incurred prior to the signing of the CA, or after it expires,

●       nuclear technologies and facilities,

●       gifts,

●       luxury goods,

Annex B

Risk Assessment 

*Risk Categories

1) External: Potential risks related to socio-economic or political circumstances beyond the control of the implementing entity. For example: civil war or political instability, systemic gender discrimination, lack of infrastructure.

2) Financial: Potential risks related to funding, misuse/mismanagement of funds or fraud. For example, currency fluctuations which reduce the amount of funding available for the project in the local currency. 

3) Operational: Potential risks related to the internal capacity of the implementing entity. For example, not having sufficient staff with the right skills to carry out the project.

 4) Safety and Security: Potential risks related to the safety and security of the recipient or beneficiaries by implement this project. For example: state surveillance, hostile environment for human rights defenders.

5) Timeframe: Potential risks related to delays in the implementation of the project affecting the achievement of outcomes.  For example: regulatory delays, seasonal delays (e.g. rainy season).

**Likelihood Categories

High Likelihood: Risk is very probable/certain.

Medium Likelihood: There is a probable chance that the risk will manifest. 

Low Likelihood: There is a remote to improbable chance that the risk will manifest. 

Annex C 

Budget Example 

ONE FISCAL YEAR

TWO FISCAL YEAR