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

A)   APPLICANT INFORMATION

1.     Descriptive Project Name:

Вистычи – территория здоровья. Формирование здорового образа жизни населения деревни Вистычи путем продолжения целенаправленной профилактической работы по воспитанию у учащихся школы и населения деревни  личной ответственности за собственное здоровье, формирование потребности в соблюдении правил здорового образа жизни, правильного питания. Ценностное отношение к своему здоровью и организму, формирование навыков правильного питания и ведению здорового образа жизни.

 

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

Ул. Центральная, 4 деревня Вистычи, Брестский район, Брестская область, Республика Беларусь.

 

Государственное учреждение образования «Средняя школа д. Вистычи»

3.     Name of applicant organization/group:

 

Contact Person

Криштапович Наталья Викторовна, директор школы

 

Name/Title:

Ул. Центральная, 4 деревня Вистычи, Брестский район, Брестская область, индекс 225031, Республика Беларусь.

Address:

8 0162 576629 +375 29 798 10 35

 

Phone/Fax:

vistychi@roobrest.gov.by

E-mail: 

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

vistychi@roobrest.gov.by

 

 

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)

Государственное учреждение образования «Средняя школа д. Вистычи». В школе обучается 260 детей. С 2014 года в школе реализуются профилактические проекты «Здоровый поселок», «Школа-территория здоровья», проводятся традиционные мероприятия в рамках данных проектов. С сентября 2022 года реализуется проект «Папа-школа» при поддержке местного территориального центра.

 

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.

 

НЕТ

 

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.

 

НЕТ

 

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)

Брестский район, Бресткая область, Республика Беларусь, Государственное учреждение образования «Средняя школа д. Вистычи», население деревни Вистычи насчитывает 780 человек.

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

Большинство школьников очень мало знают о своем теле, об особенностях его строения и функциях, о здоровье и о правильном питании как главной ценности человека. Из-за отсутствия элементарных знаний молодые люди совершают множество ошибок. К сожалению, очень часто эти ошибки становятся роковыми. Чем раньше у подростка сформируется осознанная необходимость заботиться о своем здоровье, тем здоровее будет каждый конкретный человек и общество в целом. На это и направлена деятельность проекта Вистычи – территория здоровья.

 

2.      Explanation of the project:

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

Повышение престижности и ценности здоровья, как фактора жизнестойкости, успешности, активного долголетия. Организация правильного питания подростков. Улучшение показателей физических данных детей, достижение высоких результатов в спортивной деятельности на уровне района, области, республики. Повышение уровня знаний населения по основным факторам риска для здоровья.

 

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

 

Activity	Details (description of an activity)	Activity Time frame	Immediate Results
Медицинское направление	Организация правильного и здорового питания, которое будет соответствовать возрастным особенностям детей	Сентябрь 2023 – май 2024	Снижение рисков развития различных заболеваний
Просветительское направление	Тематические классные часы, внеклассные мероприятия, игры, конкурсы, викторины, спортивные соревнования.	Сентябрь 2023– май 2024	Увеличение числа лиц оказавшихся от употребления алкоголя и табакокурения, повышение доли учащихся, активно ведущих здоровый образ жизни
Спортивно-оздоровительное	Проведение традиционных школьных мероприятий  День туриста, Тренинги Папа-школа, семинары для педагогов, родителей, детей по теме «Здоровый образ жизни», фестивали здоровья, игры, лекции с привлечением медицинских работников.	День туриста сентябрь 2023 День здоровья «Зимние забавы» январь 2024   Традиционная матчевая встреча по волейболу февраль 2024   Малые олимпийские  игры в д. Вистычи март 2024   Акция «Здоровый поселок»  апрель 2024   День здоровья «День игры» май 2024	Повышение мотивации к двигательной деятельности, здоровому образу жизни, , достижению наилучшей физической формы и самосовершенствованию учащихся, организация досуга учащихся с пользой.

 

 

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

Формирование ценностного отношения к своему здоровью и организму, к формированию навыков правильного питания и ведению здорового образа жизни, воспитанию у учащихся трудолюбия, предприимчивости и ответственности. (Акции, экологические турниры, игры, викторины, создание экологической тропы в д. Вистычи)

 

 

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:

 

Communication Medium	Number of Items	Timeframe	Planned audience
Местное СМИ	Публикации в СМИ 1 раз в месяц (будем отмечать канадское посольство	Сентябрь 2023 – август 2024
Сайт нашего  учреждения образования	1 раз в месяц (будем отмечать канадское посольство	Сентябрь 2023 – август 2024
Игстаграмм vistychi.school	1 раз в неделю (будем отмечать канадское посольство)	Сентябрь 2023 – август 2024

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?

Проект Вистычи – территория здоровья принесет пользу для каждого учащегося школы, родителей, жителей д. Вистычи

 

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)

С целью формирования здорового образа жизни населения Брестского района, продолжения целенаправленной профилактической работы по воспитанию у населения личной ответственности за собственное здоровье, формированию потребности в соблюдении правил здорового образа жизни и сознательно отказе от вредных привычек, в агрогородке Вистычи реализуется профилактический проект «Здоровый поселок», что созвучно с направлениями работы ГУО «Средняя школа д. Вистычи», ориентированной на формирование культуры здорового образа жизни.

 

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)

Проект «Вистычи  – территория здоровья» предполагает гендерное равенство, в реализации всех мероприятий будет участвовать каждый учащийся, независимо от возраста, социального статуса, с обязательным привлечением родителей учащихся.

 

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)

Все учащиеся с огромным удовольствием и энтузиазмом готовы принимать участие в данном проекте, особенно в спортивных мероприятиях.

 

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)

Все жители, в частности девочки и женщины активно поддерживают реализацию нашего проекта «Вистычи – территория здоровья»

 

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

Так как все местные жители и учащиеся нашей школы активно поддерживают проект «Вистычи – территория здоровья», организаторы данного проекта стремятся к полной реализации и выполнению поставленных задач.

 

 

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

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

Category of Risk	Description	Potential Impact on Project	Likelihood	Risk Response
Choose from the list below. (Select all that apply)	Describe each risk(s) in two sentences maximum	Explain how the risk(s) could affect the implementation of the project in two sentences maximum	How likely is/are the risk(s) to occur? ☒ Low ☐ Medium ☐ High	What will you do to respond to this/these risk(s) (in order to lower its potential impact and/or likelihood of occurrence)?
☐ External			Choose an item.
☐ Financial			Choose an item.
☐ Operational			Choose an item.
☐ Safety and Security			Choose an item.
☒ Timeframe		Внешие факторы ( эпидемиалогичская ситуация, связанная с распространением Covid19)	Choose an item.	Переносить сроки мероприятий, применять дистанционные формы работы
☐ Other			Choose an item.

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 

Type of expense	Contribution by Canada	Contribution by Recipient	Contribution by others	Total
Приобретение технологического оборудования для школьного пищеблока, с целью приготовления разнообразной и здоровой пищи для учащихся, приобретние бытовой техники, столовых приборов, посуды, мебели	$7,000
Приобретение спортивного комплекса уличных тренажеров и обустройство спортивной площадки на территории школы	$9,000
Разработка информационной кампании «МЫ за ЗОЖ»,  ( закупка материалов, оргтехники, поощрительные сувениры и подарки для детей и родителей	$3,500
Расходы на информационно-пропагандитскую деятельность, коммуникацию и распространение информации, расходы на публикации и  плата за радио - телевизионное вещание	$1,000
TOTAL	$20,500	0	0	0

TWO YEAR PROJECT

Type of expense	Contribution by Canada		Contribution by Recipient		Contribution by others		Total
Year	One	Two	One	Two	One	Two	One	Two	Final
TOTAL

 

 

 

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 

Activity or Type of Expense	Contribution by Canada	Contribution by Recipient	Contribution by others	Total
Conducting 6 capacity building sessions for women in each of the 6 villages this project addresses (purchase of materials, room rental, accommodation, facilitator fees)	$9,500	0	$5,000	$14,500
Developing the "No to Violence Against The Girl-Child" advocacy campaign (purchase materials, campaign development, web design, launch event fees)	$9,700	0	0	$9,700
Salaries (project administration and coordination cost)	$5,500	0	0	$5,500
Conducting 2 Awareness/ Dialogue sessions for leaders of  the 6 villages this project addresses (purchase of materials, consultant, facilitator, room rental fees)	$500	0	$700	$1,200
TOTAL	$25,200	0	$5,700	$30,900

TWO FISCAL YEAR 

Activity or Type of Expense	Contribution by Canada		Contribution by Recipient(s)		Contribution by others		Total
Year	One	Two	One	Two	One	Two	One	Two	Final
Conducting 6 capacity building sessions for women in each of the 6 villages this project addresses (purchase of materials, room rental, accommodation, facilitator fees)	$9,500	0	0	0	$5,000	0	$14,500	0	$14,500
Developing the "No to Violence Against The Girl-Child" advocacy campaign (purchase materials, campaign development, web design, launch event fees)	$9,700	0	0	0	0	0	$9,700	0	$9,700
Salaries (project administration and coordination cost)	$3,500	$2,000	0	0	0	0	$3,500	$2,000	$5,500
Conducting 2 Awareness/ Dialogue sessions for leaders of  the 6 villages this project addresses (purchase of materials, consultant, facilitator, room rental fees)	0	$500	0	0	0	$700	0	$1,200	$1,200
TOTAL	$22,700	$2,500	0	0	$5,000	$700	$27,700	$3,200	$30,900

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

A)   APPLICANT INFORMATION

 

1.     Descriptive Project Name:

Vistychi is a health area. Formation of a healthy lifestyle of the population of the village of Vistychi by continuing targeted preventive work to educate school students and the population of the village of personal responsibility for their own health, the formation of the need to comply with the rules of a healthy lifestyle, proper nutrition. Value attitude to your health and body, formation of skills of proper nutrition and healthy lifestyle.

 

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

4,Tsentralnaya str.,  village  Vistychi, Brest district, Brest region, Republic of Belarus.

 

State educational institution “Vistychi Secondary school”

3.     Name of applicant organization/group:

 

Contact Person

Natalya Krishtapovich , headmaster

 

Name/Title: 

 

 

4,Tsentralnaya str.,  village  Vistychi, Brest district, Brest region, index 225031, Republic of Belarus.

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

 

Activity or Type of Expense	Contribution by Canada	Contribution by Recipient	Contribution by others	Total
Conducting 6 capacity building sessions for women in each of the 6 villages this project addresses (purchase of materials, room rental, accommodation, facilitator fees)	$9,500	0	$5,000	$14,500
Developing the "No to Violence Against The Girl-Child" advocacy campaign (purchase materials, campaign development, web design, launch event fees)	$9,700	0	0	$9,700
Salaries (project administration and coordination cost)	$5,500	0	0	$5,500
Conducting 2 Awareness/ Dialogue sessions for leaders of  the 6 villages this project addresses (purchase of materials, consultant, facilitator, room rental fees)	$500	0	$700	$1,200
TOTAL	$25,200	0	$5,700	$30,900

TWO FISCAL YEAR

 

Activity or Type of Expense	Contribution by Canada		Contribution by Recipient(s)		Contribution by others		Total
Year	One	Two	One	Two	One	Two	One	Two	Final
Conducting 6 capacity building sessions for women in each of the 6 villages this project addresses (purchase of materials, room rental, accommodation, facilitator fees)	$9,500	0	0	0	$5,000	0	$14,500	0	$14,500
Developing the "No to Violence Against The Girl-Child" advocacy campaign (purchase materials, campaign development, web design, launch event fees)	$9,700	0	0	0	0	0	$9,700	0	$9,700
Salaries (project administration and coordination cost)	$3,500	$2,000	0	0	0	0	$3,500	$2,000	$5,500
Conducting 2 Awareness/ Dialogue sessions for leaders of  the 6 villages this project addresses (purchase of materials, consultant, facilitator, room rental fees)	0	$500	0	0	0	$700	0	$1,200	$1,200
TOTAL	$22,700	$2,500	0	0	$5,000	$700	$27,700	$3,200	$30,900