2014 Whitley Award Application Form

This application form should be completed with the help of the Guidance for Applicants Document. Guidance is available on all questions.

1. Name of Applicant
2. Country 3. Title of this application 4. Information on organisation/ initiative
Name of organisation: Status (NGO, charity, non-profit, society, University etc.): - If not working through an NGO, please describe the context for project delivery: Date organisation established: Charity number: Age of Project for which applying:

5. Contact Details in full

Address: Telephone (include international code): Email/s (indicate preferred): Website/s: Known periods when project leader will be unavailable :

6. Location of project/study site

i) Location(s) + brief description (please submit maps as separate attachments): ii) Latitude: Longitude:

7. How did you hear about the Whitley Awards/ Whitley Fund for Nature?
How heard of Awards/WFN Direct contact from WFN Details / Who

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Previous Whitley Award winner Colleague WFN Website Non-WFN website Other

8. Have you previously received funds from either:

The Whitley Fund for Nature (previously called the Whitley Laing Foundation)? Yes No

Any grant from the Rufford Foundation or Rufford Small Grants Foundation? Yes
If Yes for either question a. b. c. d. when did you receive funds? type of Award/grant how much were you awarded? what was it for (name of project/ leader/ location )?

No

If you have an outstanding application with the Rufford Foundation, give details. If this is not your first application for a Whitley Award, please give details of all previous applications.

9. Personal Summary - (no more than 500 words)

i) ii) iii) iv) v) vi) Nationality: Current job title/ position: Date of Birth AND Age: Education/training: Languages: Previous related work:

vii) Awards and achievements: viii) Experience as a team leader (use bullet points):

10. Executive summary - (100 words) 11. Your Works Objectives (no more than 600 words)
i) Issue(s) you are addressing: ii) Aims and objectives (what do you want to achieve?): iii) Project beneficiaries: iv) Origin of project: v) Evidence of success to date:

12. Activities and methodology

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13. Proposal Logframe

Example:
OVERALL OBJECTIVE: Effective protection of the Lower Mekong Basin Outputs Activities and methodology (including how progress will be monitored - note: not everything has to be monitored) Risks / Assumptions (and how you will overcome them) Outcomes (what is required to achieve the objective)

OUTCOME 1: Improved human and technical capacity to conserve wetland biodiversity in the Lower Mekong Basin

Output 1.1: Regional and national support structures for all project activities established and operational Output 1.2: Wetland biodiversity conservation issues including illegal trade in wetland species, integrated into existing regional training initiatives Output 1.3: Wetland biodiversity conservation training programmes operating in four countries

14. Measuring impact/success 15. Timeline

Month Activity Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

16. Project need and urgency (no more than 250 words) 17. Project Sustainability 18. Your Team members
Name Age Gende r Nationality Role and employer Qualifications/ Experience Where based and Full/ Part time? (giving hours per week to be spent on proposed project)

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19. Collaborating organisations/ groups - Please indicate whether relationship is already

active or proposed.

20. Dissemination of results

I confirm I have understood WFN aims to share, with my help, elements of the report from this Whitley Award grant with other members of the Whitley Award Alumni via the WFN website to facilitate the sharing of best practice in conservation. Yes

21. Your Conservation Outlook

- (no more than 350 words)

22. Photographs - These must be submitted as individual files separately to this form. Do not
insert image files into the table below.

Photo number, your surname, photo name, date taken (to correspond with file name of the photograph you attach). Example 1_Smith_bushmeat_March11 1 2 3 4 5 6 7 8 9 10

Photo caption (include subject and where taken)

Example Bushmeat confiscated from illegal hunters from Galmond National Park

23. Footage and photos 24. Summary Financial questions

ALL NGOs Projects What was your NGO/organisations total income and expenditure last Financial Year (FY)? Total of funding proposals currently pending for your NGO/organisation across all programmes and for other purposes: This Specific Project What was income and expenditure Local Currency Income: Expenditure: GBP Conversion Income: Expenditure:

Local Currency Income:

GBP Conversion Income:

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last Financial Year (FY) for this specific project (or previous related project if new)? Total funding required for this specific project for next year (all donors): Total funding already secured for this specific project for next year (all donors): Total of funding proposals pending for this specific project:

Expenditure:

Expenditure:

Rate of exchange used & date: __________________________________ 25. Financial Information A) Financial Governance
Please submit the following items separately along with your application unless indicated otherwise. Please do not embed scans of documents into this application form.

i) NGO/organisation Founding documents (e.g. constitution, registration certificate): ii) Latest Audited Financial Statements/Accounts (or alternative, if not available): iii) Explanation of Financial Controls of your NGO/organisation:

B) Project Budgeting
All budgets MUST be in GBP. Include rate of exchange used for conversions

i) Historical Project Budget: ii) Forecast Project Budget (must be inserted into document and NOT as a separate attachment): iii) Explanation of Budget:

26. Your Fundraising A) For the Project - In the table below, please state:
Funding already secured for this specific project for next year (all donors) other funding applications for the project made within past 12 months which were declined Current or planned funding proposals with outcomes pending for this specific project

Name of funding body

Funding amount applied for (GBP )

Date of proposal

Date of decision

Outcome (granted, pending or declined)

Grant start & end dates (and year)

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B) For the NGO / Organisation - In the table below, please state:

other current funding secured for your NGO/Org for next year not related to this project. other funding applications for your NGO/Org not related to this project made within past 12 months which were declined Total of funding proposals for your NGO/Org not related to this specific project with outcomes pending

Name of Funding body

Funding amount applied for (GBP )

Date of proposal

Date of decision

Outcome (granted, pending or declined)

Grant start & end dates (and year)

C) List all current major donors (more than 3,000 per year) for your NGO 27. Delivery of funds 28. Referee Statements
NAME 1. 2. 3. POSITION ADDRESS TELEPHONE EMAIL (required)

29. Declaration from the Applicant

The information submitted in this application is true, to the best of my knowledge, information and belief. Should any significant developments arise after this application is made, I shall notify the WFN office immediately. I consent to the information contained in this application being held on computer and circulated to members of the Whitley Judging Panel, other interested parties and the media, under the terms of the Data Protection Act, 1984. I have requested the three referees named above to send their reference statements directly to the WFN office by the deadline and I understand that the opinions of referees and reviewers remain confidential to WFN and the Whitley Judging Panel and will not be disclosed to me, the applicant. I furthermore understand and give permission for the photographs I have sent in support of my application, and any further photos, video footage, music and any other visual and audio materials I later forward as part of my application, may be used to promote my work in the media, and other locations WFN deem appropriate, including in WFN publication materials and at the Whitley Awards Ceremony, and, should my application be successful, to promote the WFN as a donor to my work. I understand it is my responsibility to secure right of use over such materials before forwarding them to WFN and that I consent to their use by WFN as stated. I understand that the Whitley Awards is an international competition and that the Judging Panels decision is final. I furthermore understand the Whitley Awards aim to fund and champion the work of dynamic conservation leaders who are effective communicators dedicated to spreading positive conservation learning and understanding globally. I understand what the Whitley Award is, a monetary grant to support the work outlined in this proposal, and a publicity prize applied for by conservationists who seek publicity for their work and who share the collaborative ethos outlined above.

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Should I succeed in being shortlisted as a finalist, I will be invited to the U.K. for interview by the Judging Panel and to take part in a week of events in London in early/mid May. I understand that if I am selected as a finalist but am unable to come to interview in May this constitutes withdrawal from the competition. I understand that if I am selected as a finalist, I will be asked to provide video footage of my project work and further photographs to supplement my application, and that I will do everything I can to provide these materials quickly. I understand that if I win the Award the WFN team will assist me in publicising the work of my project and that, whilst publicity success is not guaranteed, I will do all that I can to assist WFN and will proactively take forward appropriate media opportunities. I confirm that to the best of my understanding and knowledge, winning the Whitley Award and attracting any associated publicity will benefit and do no harm to the conservation project or associated communities described in this proposal.

Signature & Date

_______________________________________________

IN CONFIDENCE

GUIDANCE FOR REFEREES - WHITLEY AWARDS 2014

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Applicant Name........................................................................................................................... Application Title ........................................................................................................................ Referee Name............................................................................................................................... Referee Position..........................................................................................................................

The applicant named above has applied to The Whitley Fund for Nature (WFN) for a Whitley Award, a major international nature conservation award. We would be grateful if you could give the Judging Panel your candid opinion about the applicant and work indicated above. The applicant must provide you with a full copy of the completed application form to assist you in your reference. Your reference will be one of the key factors the Judging Panel takes into account in their assessment.

Background to WFN - WFN is a UK registered charity offering Whitley Awards to outstanding nature
conservationists around the world. We locate and recognise dynamic conservation leaders and support projects founded on good science, community involvement and pragmatism. The charity offers funding and immediate recognition to people who bring about change, and champions passionate individuals who are committed to long-lasting conservation benefits on the ground. Applicants are not restricted to qualified scientists, but must be able to compile a written report to describe and quantify the success of their work with appropriate references. Applicants need to be able to communicate in English. Undergraduate and school level expeditions are not eligible, and nor are projects carried out in support of higher degrees. More information about the WFN and previous award and grant recipients may be found on the charitys website at www.whitleyaward.org

The reference - Please write a reference giving your opinion about the pragmatic and long-lasting impact
of the work in question; how the applicant is known to you; the applicants ability to lead a team; the ability of the applicant and team to communicate the solution to the problem they are addressing; the strength of the proposed activities and methodology; how the project will make a difference to nature conservation; and any other information that might help the Panel. Should the applicant succeed, they will receive Whitley Awards worth 35,000 GBP in funding. We would therefore also value your candid opinion about the applicants ability to absorb and spend the level of funding they are seeking, with due responsibility.

Submission of reference - The reference must be sent as a scan of a signed letter, on headed paper
in PDF format. The subject line of the email should include Ref WA14, the applicants full name and your surname. References must be submitted independently by the referee directly to WFN . Any references that are not submitted independently by the referee will not be considered.

Deadline - Please submit your reference by email to info@whitleyaward.org BEFORE THE DEADLINE
OF THURSDAY 31st OCTOBER 2013. This is very important, as the applicants application will not be considered without the receipt of all three references before the deadline.

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