Objective:
To ensure that facilitators, DAs and technical advisers are aware of the details required to complete a CDF application form for different microprojects and the content of a Grant Agreement Form.
Forms:
1 Application Form for Community Microproject Grant
2 Application Form for Household Microproject Grant to Improve Living Conditions
3 Application Form for Cooperative Working Capital Grant
4 Grant Agreement Form
IMPROVING NUTRITION AND HOUSEHOLD FOOD SECURITY IN N.SHEWA AND S.TIGRAY FAO/BSF Project
COMMUNITY DEVELOPMENT FUND: APPLICATION FORM
1. COMMUNITY MICROPROJECT
Name of community group: .................................................................................
Kushet/Gott: ................................................. Tabia/Kebelle: ...................................................
Application for a grant of Birr ......................... Date received by WFSCD ...........................
Microproject for which grant is required:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Attach copy of Microproject Activity Plan and Time Plan for Input Requirements relating to this project.
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How many households will benefit from this microproject? |
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How many are female headed households? |
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How many are in the most vulnerable household group? |
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How many have been involved in the planning process? |
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Summarise the in-kind community contributions proposed, e.g. materials, labour, input purchasing, organisation and supervision, etc.
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Summarise the cash requirements (from Time Plan for Input Requirements):
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TOTAL |
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List members of community group or committee that has been formed to take charge of this project:
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Attach the Maintenance / Operational Plan prepared by community.
DECLARATION
We declare that the information we have given above and in support of this application is to the best of our knowledge correct. We undertake to ensure this microproject is completed and will supply receipts for all grant funds used to the Tabia / Kebelle Steering Committee.
Signature of Chairperson:.....................................................................................................
Signature of Secretary:.........................................................................................................
Signature of Treasurer:.........................................................................................................
Date:....................................................................................................................................
To be completed by Kebelle / Tabia Food Security / Development Committee:
Appraisal of the experience, skills and ability of this group to implement this project:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Recommended disbursement plan:
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Amount |
Method (e.g. cash / materials / to whom, etc.) |
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Signature of Chairman: ____________________________ Date: _____________________
IMPROVING NUTRITION AND HOUSEHOLD FOOD SECURITY IN N.SHEWA AND S.TIGRAY FAO/BSF Project
COMMUNITY DEVELOPMENT FUND: APPLICATION FORM
2. HOUSEHOLD MICROPROJECT: Improving Living Conditions
Kushet/Gott:.....................................................Tabia/Kebelle:......................................................
Application for a grant of Birr............................Date received by WFSCD..............................
Proposed intervention, e.g. building latrines, introducing fuel-saving stoves, etc.:
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Attach a list of the Group members responsible for selecting beneficiary households.
How many households have been selected for assistance? ..................(Attach list of names)
How many are female headed households?...................
How many are in the most vulnerable category?...................
How many have been involved in the planning process? ...................
Summarise the in-kind household contributions proposed, e.g. materials, labour, input purchasing, etc.
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Summarise the cash / material requirements:
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Items to be purchased with cash |
Amount needed |
Items to be supplied in kind |
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Name of Coordinator for this microproject.....................................................................
DECLARATION
We declare that the information we have given above and in support of this application is to the best of our knowledge correct. We undertake to ensure this microproject is completed and will supply receipts for all grant funds used to the Tabia / Kebelle Steering Committee.
Signature of Chairperson:.....................................................................................................
Signature of Secretary:.........................................................................................................
Signature of Treasurer:.........................................................................................................
Date:....................................................................................................................................
IMPROVING NUTRITION AND HOUSEHOLD FOOD SECURITY IN N.SHEWA AND S.TIGRAY FAO/BSF Project
COMMUNITY DEVELOPMENT FUND: APPLICATION FORM
3. COOPERATIVE SOCIETY WORKING CAPITAL
Kushet/Gott:.....................................................Tabia/Kebelle:......................................................
Name of Cooperative Society: ....................................................................................
Application for working capital grant of Birr.......................Date received by WFSCD................
Inputs that the cooperative will stock to meet member requirements:
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Quantity |
Cost Price |
Total Cost |
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Attach the business plan and cash flow for the next year of the Cooperative Society’s operations.
Attach details of the membership policy and arrangements made for poor households to purchase share capital in instalments or by group membership.
Attach rules for credit sales to members and guarantee requirements.
How many poor and vulnerable households are members of this cooperative? ...................
How many have been involved in planning meetings of the cooperative? ...................
DECLARATION
We declare that the information we have given above and in support of this application is to the best of our knowledge correct.
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Signatures: |
Date:.................................................. |
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Society Chairman |
Society Secretary |
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Society Treasurer |
Chair of Microproject Planning Committee |
IMPROVING NUTRITION AND HOUSEHOLD FOOD SECURITY IN N.SHEWA AND S.TIGRAY FAO/BSF Project
COMMUNITY DEVELOPMENT FUND
GRANT AGREEMENT FORM
The WFSCD has approved a Grant of Birr..........................................................................
Amount in words...................................................................................................................
For (name of coordinator, group or cooperative):.............................................................
Kushet/Gott:...................................................Kebelle/Tabia: ..........................................
For the purpose of..............................................................................................................................
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Conditions of agreement:
1. All receipts relating to expenditure of Grant money must be kept and submitted to the Kebelle/Tabia Food Security Committee at the end of each month until purchasing has been completed.
2. ________________________________________________________________________________
3. ________________________________________________________________________________
4. ________________________________________________________________________________
Estimated completion date for Community Microprojects and Household Microprojects to improve living conditions..............................................
Signed on............................... at..........................................................................................
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NAME |
SIGNATURE |
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For WFSCD |
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Recipient or Chairperson |
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Secretary |
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Treasurer |
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