U.S.

EMBASSY GRANTS PROGRAM

APPLICATION FORMAT FOR ORGANIZATIONS

Read carefully the instructions supplied with this document.

The applications that do not follow the guidelines and the instructions provided with
this form will not be reviewed.

Prepare your answers using this format and submit them using the
following link:

https://forms.office.com/g/QtwWTqnUEk

IMPORTANT:

 This document should be completed in English Language

 Please prepare all your answers in a word document and then use this form to
copy-paste and submit the answers.
 When you submit the application, you will receive a confirmation message.
Reply to that message including the attachments required for this submission.

Funding Opportunity

Please select funding opportunity from the list on the website.

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Applicant Organization
Please provide details about the applicant organization. Please enter the Legal Name
exactly as it appears on the registration documents. Bank Account Holder Name is
the Name of the organization as it appears in your bank account.

SAM.GOV registration is mandatory for all grants. Refer to the instructions included in
the Notice of Funding Opportunity.

Fiscal Code (non-US) or EIN (U.S.) is a mandatory field. The fiscal code is used to
check the legal status and validate the registration of the applicant organization.

Legal Name

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Please enter the Legal Name exactly as it appears on the registration documents.
Do not translate. Enter the legal name of the applicant that will undertake the
assistance activity. This is the organization that has registered with the System for
Award Management (SAM).

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Type of applicant
Select the applicant type from the list

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Unique Entity Identifier (UEI):

Enter the organization’s UEI received from SAM.gov. The UEI is a unique 12
character organization identifier.

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EIN (US Organizations) or Fiscal Code (Moldovan organizations)

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Address: Street:
Enter address: Street

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Address: City
Enter address: City

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Address: State/Raion
Enter address: State or Raion

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Address: ZIP/Post code

Enter address: ZIP code (US) or Postal Code

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Address: Country
Enter address: Country

Choose an item.

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Authorized Representative
Please provide information about the name of the person who is authorized to sign a
grant agreement on behalf of the organization.
A copy of the governing body’s authorization for you to sign this application as
the official representative must be on file in the applicant’s office.

Authorized representative First Name:

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Authorized representative Last Name:

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Authorized representative Job Title:

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Authorized representative Telephone:

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Authorized representative Mobile Telephone:

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Authorized representative Email:

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Contact Person (Project Coordinator)
Please provide information about the person to be contacted on matters involving this
application.

Contact Person First Name:

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Contact Person Last Name:

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Contact Person Job Title:

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Contact Person Telephone:

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Contact Person Mobile Telephone:

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Contact Person Email:

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Project Description
Project Title:

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Project Start Date

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Project End Date

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Areas affected by Project

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Executive Summary/Project Abstract summary (4000 characters)

Ensure the Project Abstract field succinctly describes the project in plain language
that the public can understand and use without the full proposal. Use 4,000
characters or less. Do not include personally identifiable, sensitive or proprietary
information. If the application is funded, your project abstract information (as
submitted) will be made available to public websites and/or databases including
USAspending.gov.

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Project Justification: (4000 characters)

Use the space below to justify why your project is important. Write about the problem
the project intends to address and qualifications of the organization. Explain the need
of the project.

sfgsfg

Project Goal and Objectives (4000 characters)

In this section of the proposal, state the overall project goal and the specific
objectives that will be achieved during the project.

Project Goal
The project goal refers to a general, long-term change, such as a change in attitudes
or in public policy.

ertersdfsdsdfsdfft

Project Objectives (4000 characters)

Objectives refer to the intermediate changes, are more specific than goals and refer
to a specific location and time. Unlike a goal, which a project will only partially
contribute to achieving, the project objectives do need to be achievable and
measurable within the scope of the project. Make sure your objectives are SMART

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(Specific, Measurable, Appropriate, Realistic and Time-Bound)

sdfsdfsdf

Project Activities
In this section of the proposal, provide more details about the specific activities that
will be conducted. The activities should support the achievement of the objectives.
You may add up to 10 activities.

Activity 1: Title:

sssdfsdfsss

Activity 1: Description (max. 4000 characters)

Activity 2: Title:

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Activity 2: Description (max. 4000 characters)

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Activity 3: Title:

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Activity 3: Description (max. 4000 characters)

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Activity 4: Title:

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Activity 4: Description (max. 4000 characters)

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Activity 5: Title:

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Activity 5: Description (max. 4000 characters)

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Activity 6: Title:

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Click or tap here to enter text.

Activity 6: Description (max. 4000 characters)

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Activity 7: Title:

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Activity 7: Description (max. 4000 characters)

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Activity 8: Title:

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Activity 8: Description (max. 4000 characters)

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Activity 9: Title:

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Activity 9: Description (max. 4000 characters)

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Activity 10: Title:

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Activity 10: Description (max. 4000 characters)

Monitoring and evaluation (4000 characters)

This section provides details on how the effects of the intervention will be measured.

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Key Personnel (4000 characters)

Include information about the project team. Who will work on this project? What are
their qualifications and responsibilities?

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Project Partners (4000 characters)

Who will be your partners in the implementation of this project? Describe the role of

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each partner.

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Strengths and Innovation (4000 characters)

This section of the proposal is a place for you to describe what is innovative or
interesting about your project, what sets it apart from other projects.

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Sustainability (2000 characters)

Sustainability refers to the ability of a project to continue once the initial grant or
external source of funding has ended.

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Budget Summary
Include information about estimated funding requested from the U.S. Embassy

Personnel
Include the total for salaries of temporary or permanent staff who will be working
directly for the program. Please take the information from the Summary section of
the Detailed Budget Template

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Fringe Benefits
Include the benefits of temporary or permanent staff who will be working directly for
the applicant on the program. Check with the program if these benefits are
allowable.

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Travel
Include the costs of travel (tickets, fuel, car rent, accommodation, per diem) for this
program, for program staff, consultants or speakers, and participants/beneficiaries.

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Equipment
Describe any machinery, furniture, or other property that is required for the program,
which has a useful life of more than one year (or a life longer than the duration of the
program), and costs at least $5,000 per unit. For example, a laptop of $1,500 should
not be included in this category because it is less than $5,000.

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Supplies
List and describe all the items and materials, including any computer devices, that
are needed for the program. If an item costs more than $5,000 per unit, then put it in
the budget under Equipment. Consider grouping small expenses (For example,
include Conference supplies for two events instead of separate lines for expenses
like pens, folders, markers, paper, etc).

Construction Costs

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Contractual
Describe goods and services that the applicant plans to acquire through a contract
with a vendor. All relevant taxes should be included. Also describe any sub-awards to
non-profit partners that will help carry out the program activities.

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Other Direct Costs
Describe other costs directly associated with the program, which do not fit in the
other categories. For example, shipping costs or applicable taxes, . All “Other” or
“Miscellaneous” expenses must be itemized and explained.

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Indirect Costs
These are costs that cannot be linked directly to the program activities, such as
overhead costs needed to help keep the organization operating. If your organization
has a Negotiated Indirect Cost Rate (NICRA) and includes NICRA charges in the
budget, attach a copy of your latest NICRA. Organizations that have never had a
NICRA may request indirect costs of 10% of the modified total direct costs. Please
confirm if program supports indirect costs.

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Non-Federal Funding
Applicant Contribution
Enter 0 if you do not have applicant contribution

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Contribution by other organizations

Enter 0 if you do not have contribution by other organizations

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Estimated Program Income

Enter 0 if you do not anticipate having program income

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Certifications
Is the Applicant Delinquent On Any Federal Debt?
Select the appropriate box. This question applies to the applicant organization, not
the person who signs as the authorized representative. Categories of federal debt
include; but may not be limited to: delinquent audit disallowances, loans, and taxes. If
yes, include an explanation in the field below.

Yes No

If Yes:
Federal Debt Delinquency Explanation:

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Certifications
The list of certifications and assurances, or an internet site where you may obtain this
list, is contained in the announcement or agency specific instructions.

By submitting this application, I certify (1) to the statements contained in the list of
certifications** and (2) that the statements herein are true, complete and accurate to
the best of my knowledge. I also provide the required assurances** and agree to
comply with any resulting terms if I accept an award. I am aware that any false,
fictitious, or fraudulent statements or claims may subject me to criminal, civil, or
administrative penalties. (U.S. Code, Title 218, Section 1001)

PLEASE SUBMIT THE INFORMATION FROM THIS DOCUMENT ELECTRONICALLY IN

ORIGINAL FORMAT.

https://forms.office.com/g/QtwWTqnUEk

Last Updated: 01/04/2023

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