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ORGANIZATION INFORMATION
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1. Name of Organization: (Please do not use acronyms.)
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2. Name of Contact person :
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3. Title (Dr., Mr., Miss., Ms.)
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4. Designation of primary contact
within organization:
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5. Landline number: Please include area
code and extensions, if any.
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6. Mobile number:
(Do not put spaces)
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7. Fax number:
(Do not put spaces)
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8. Email Address:
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9. Website (if available):
(Do not put spaces)
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10. Street Address:
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11. City/ Town/ District / Village:
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12. State:
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13. PIN Code:
(Do not put spaces)
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14. Type of legally registered organization : Please tick the appropriate box.
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Section 25 Company
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Cooperative
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Trust
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Society
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Private Limited Company
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Partnership
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Other ( please specify)
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15. Please describe the history of your organization, including date of establishment,
current number of employees
and mission statement (Word limit: 300)Word Count : 0
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16. How long has your organization been in operation (in number of years)?
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17. Is your organization a woman-owned enterprise?
Yes
No
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18. Please describe the current work of the organization – what functional and geographic areas are you active in?
(Word limit:
300)Word Count : 0
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19. Please describe the leadership team of your organization – their background and role in daily operations.
(Word
limit: 300)Word Count : 0
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BASIC PROPOSAL INFORMATION
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20. Title of project proposal : Avoid using general titles (such as "Supporting Inclusive Business Models") that do not
describe your specific project.
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21. Current location of the Project : Please tick all that apply.
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22. How long has your Project been in operation? Please tick the appropriate box.
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23. With the Grant, where would you want to replicate or scale the project, select all that are relevant:
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| 24. Total funding requested in INR:
(Please note that the total amount cannot exceed the INR equivalent of USD 50,000.)
Rs.
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PROPOSAL DETAILS
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25. Project Objective and Description: Please provide in brief;
- The project objective
- Expected outcomes
(Please reflect the overall goal of improving the livelihoods of poor communities either by 1) delivering
infrastructure or goods/services; or 2)contributing to increased income mobility) (Word limit:
300)
Word Count : 0
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26. Social Impact Current:
Please demonstrate the Project’s positive social impact to date and supply metrics
and indicators on how such impact is being measured.
Note:
Indicators can either be quantitative or qualitative. In either case, indicators should be clear, discrete and
measurable. (Word
limit: 200)
Word Count : 0
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27. Social Impact Future:
Please indicate how the organization plans to scale up/replicate its impact in a two to
three years period and provide indicators that will be used to measure it.
To the extent possible, provide
quantitative information/estimates of the expected results (e.g. number of beneficiaries, % of change in income, etc.)
(Word limit: 200)Word Count : 0
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28. Sustainability: Please demonstrate the project’s existing sustainability as:
-Organizational Sustainability: Describe the organization’s structure and its capacity to implement the project and
sustain the results.
-Financial Sustainability: Demonstrate that the organization is on the pathway of financial self-sufficiency.
Describe the key sources of risk in meeting your goals and strategy to mitigate the same. (Word limit: 400)
Organizations will need to upload copy of -
a) Financial statements for the past 2 financial years,
b) A project plan with operating and financial forecasts for the next 3-5 years
Word Count : 0
Please upload Financial Statements (File Size - Max 1
MB)
Please upload Project Plan (File Size - Max 2 MB)
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29. Growth Potential A):
Please indicate the characteristics that demonstrate project potential for being replicable/
scalable and of interest to social and mainstream venture investors.
Organizations can provide their own metrics
to measure scale and financial sustainability. (Word limit: 200)
Note:
Replicability- is when a project can be adopted by other group beyond the given geographical area of the project
implementation.
Scalability- is when a project can be expanded within a geographic area to benefit more people in the project area. Word Count : 0
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30. Growth Potential B): Please state the amount and type of funds the enterprise needs to raise beyond the
resources generated by the grant for successful scale implementation. (Word limit: 200)
Word Count : 0
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| 31. Innovation Potential:
Proposals should indicate the extent to which the organization and project have an
innovative and inclusive approach to lowering costs and enhancing affordability. (Word limit:
300) Word Count : 0
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BUDGET
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32. Please download and fill the Budget Template (Download Template) to demonstrate how you plan to deploy the
Grant funds over a 2 year period. The budget template is only for reference and organisations can add other budget
heads, if required, for their project. (File Size - Max
1 MB)
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