Development Aid for People with Disabilities

FAST TRACK SMALL GRANT APPLICATION FORM

Details of the applicant
1. Name of the applicant organization / group:
2. Title of the project:
3. Name and position of the person responsible for the project:
4. Mailing Address of the organization / group:
5. Telephone:
6. Fax:
7. Email:
8. Location of the office of the organization / group:
9. Project duration (the planned dates for the project implementation):
Starting date_______________
Finishing date_________________
10. When was your group/organization registered? __________________
Where?
1) with the national government
2) with the regional government
3) with local government
4) not registered yet/ in the process of registration

11. Who are the board members in your organization / group?

Full name

Sex

Disability
(if any)

Position in
the board

Fast Track Small Grant - Application form

Profession
(if any)

Signature

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12. Please choose suitable answers for describing your organization / group
today.
1) enough number of members,
2) enough number of active members,
3) good funding situation,
4) good contact with decision makers (ex. local authorities),
5) good contact with other NGOs,
6) community appreciate the organisation,
7) others (please, mention).
8) if you want, please describe the status of your organization.
13. Does your organization / group have a bank account of your own? Please
give the details:
Name of the bank
Address of the bank
Name on bank account
Number of bank account

Project details
14. Brief description of the project
15. Why do you want to implement this project?
16. What are the goals of the project?
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Development Aid for People with Disabilities

17. Which groups of persons with disabilities are included in your project?
1) persons with physical disabilities,
2) deaf persons,
3) Persons with partial hearing loss / hard of hearing persons,
4) blind persons,
5) persons with visual disabilities,
6) persons with mental disabilities / psychosocial disabilities,
7) persons with intellectual disabilities,
8) deaf blind persons,
9) persons with other multiple disabilities,
10) persons with Albinism,
11) persons with HIV/AIDS,
12) persons with Autism,
13) persons with disabilities in rural areas,
14) women with disabilities,
15) youth with disabilities,
16) children with disabilities,
17) parents of children with disabilities,
18) persons with chronic disease, and
19) others (please mention)
18. How many women with disabilities and men with disabilities are included?
Please answer in numbers.
Women with disabilities:
Men with disabilities:

__________
__________

19. How many children with disabilities are included? Please answer the numbers
of girls with disabilities and boys with disabilities separately.
Girls with disabilities:
Boys with disabilities:

__________
__________

20. Where will the project take place?

21. What are the activities of the project?

Activity

Fast Track Small Grant - Application form

Person
responsible

When

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Development Aid for People with Disabilities

Budget details
22. Budget
Exchange rate: 1 Euro =
Date of exchange rate:
Item

Grant

Self financing

Total

23. What does your organization / group want to do for the next five years?

Signature:
Date and place: __________________________________________
Signature: ______________________________________________
Name and position in block letters: ____________________________
Stamp/Seal:

FAST TRACK SMALL GRANT APPLICATION FORM

INSTRUCTIONS
1.
2.
3.
4.
5.
6.

Name of the organization / group

Title of the project
Name and position of the person responsible for the project
Address of the organization / group
Telephone (of the organization / group)
Fax (of the organization / group)

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Development Aid for People with Disabilities

7. Email (of the organization / group)

Make sure all the contact information is correct.
8. Location of the office of the organization / group
Describe the physical location of the office.
9. Project duration
When do you plan to start the project? When do you plan to end the project?
10. Registration details of your organization / group
Tick the appropriate box
11. Board Members of your organization / group
Please fill in the table with information of your board members.
12. Current situation of the applicant organization / group
Details of your organization / group now. Choose the suitable answers. You
can choose more than one. Please feel free to describe the situation of your
organization / group.
13. Banking details
Give the details of the bank where the account is held, bank account name
and number and the address of the bank.
Project details
14. Brief description of the project
Briefly describe the project what does it involve? Starting an incomegenerating activity? If so, describe the proposed activity, i.e. products to be
produced, services to be provided, etc. Providing skills training? If so,
describe what skills and where the training will take place. Be specific.
15. Why do you want to implement this project? What problems or needs
do you want to address? Describe what is the current situation of people with
disabilities?
16. Goal(s) of the project
Describe what are the planned results you want to achieve?
17. Participants of the project
Which persons with disabilities are included into your project? Choose suitable
answers. You can choose more than one.
18. Equal participation of women and men
Are your organization / group paying attention to equal participation of women
and men? Please give the answers in numbers.
19. Inclusion of children with disabilities
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Development Aid for People with Disabilities

Are children with disabilities included? Children with disabilities are defined
those under the age of 21. Are your organization / group taking gender
equality among the children with disabilities seriously? Please give the
answers in numbers.
20. Where will the project take place?
Give a description of the physical location of project activities.
21. Project activities
List all planned activities and give details on who participates the activities,
when and where.
22. Budget
Use local currency in the budget and list all main costs of the project,
according to the planned activities. Keep the budget realistic and within the
local price level.
23. Plans for the future
Describe how you plan to continue your activities after the grant from Abilis
has been used.
Sign the application and attach relevant documents such as copy of your registration and
bank statement of the organization / group and one recommendation letter.

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