SRI LANKAN ASSOCIATION OF GENEVA

Case postale 41, CH 1211 Geneva 19, Switzerland

Assistance for Needy Causes in Sri Lanka

Application Form

*Before completing this form, please read the ‘Guidelines for Applicants’ carefully.

Type or print in capital letters and return the signed form to SLAG.

SLAG Member Proposing the Project

Name:

Phone:

Address:

 

E-mail:

 

Fax:

Signature:

Project Information

1. General

Project Title (if relevant):

Beneficiary / Beneficiaries:

Arrangement for carrying out task/s:

 

Responsible Person:

 

 

Contact Details:

Alternate Responsible Person:

 

Contact Details:

 

 

Funds to be remitted to (give Bank details if relevant):

Amount requested (Please state currency):

2. Brief description of project (you may attach a detailed description):
 
 
 
 
 
 

 

3. Objectives of the project for which you are applying for funds:
 
 
 

4. Expected time of completion after receipt of funds:

5. Verifiable outputs:
 
 
 

6. List the items on which you will spend the funds and the estimated cost:
 
 
 

7. How will expenditure and outputs be monitored:
 
 
 
Statement by Responsible Person
I certify that the above information is correct and that our project is not receiving financial support for the same needs/items from any government, international organisation or agency.

Should this project receive financial support from SLAG, I undertake to provide SLAG with an acknowledgement upon receipt of the funds, and a brief evaluation report of the project no later than 6 months after receiving the donation.

Name:

 

Place:

Signature:

Date:

Guidelines for Applicants

  1. The project must be sponsored by a current Signature:member of SLAG and should only be for a project that has not received prior funding from SLAG. Repeat funds would require very strong justification and will be considered only exceptionally.
  2. The application must be submitted, through a member of SLAG and signed by the responsible person in Sri Lanka. Applications in electronic format will also be accepted,, provided it is accompanied by an email confirming signature.
  3. Preference will be given to small projects in Sri Lanka which are focused on the marginalized needy and poor and for which external funds are necessary and/or strategic.