Grant Application

GRANT PROPOSAL FORM

PERSON FILLING OUT THIS APPLICATION:

First name*

Last name*

Address*

Phone Number*

Email*

RECIPIENT DETAILS:

Please fill out details about the person or entity requesting the grant

IS THE RECIPIENT AN INDIVIDUAL, ORGANIZATION, or GROUP?IndividualOrganizationGroup

* "Individuals" are people who have had success in implementing community-based projects and have relationships with the local community.
* "Organization" is a business, NGO, or religious entity that is registered with the state.
* "Groups" are unregistered entities that are embedded in the community where the project takes place. They have a defined leadership structure and a vision to support their local community.

Name of Individual, Organization, or Group*

Address*

City*

Local Government Area*

Phone Number*

Email*

IF AN ORGANIZATION OR GROUP, PLEASE LIST THE MAIN POINT OF CONTACT:

Name*

Phone Number*

Email*

Is this business registered with the Corporate Affairs Commission of Nigeria?YesNo

If "yes", state the type of entity registered:EnterpriseCooperativeLimited LiabilityPartnershipSole ProprietorNon Governmental Organization

Amount of Funds sought. ₦

Other Funds Already Raised Specifically for this Project. ₦

Total Project Cost (PSDAA + Fundraised amount): ₦

Brief summary of project (1-3 sentences):

Provide one sentence on what you are requesting funding for (i.e. construction of a building, equipment, supplies, etc.):

Describe any current or past projects completed by recipient in the last 6-12 months:

Do you have a business plan or written project plan?YesNo

ELIGIBILITY DETAILS:

Does your organization agree to not discriminate against religion, sex, ethnic tribes, non-indigenous peoples, poor people, disabled people?YesNo

What type of Support are you seeking?HealthEducationOther

If Health, please describe the type of facility (i.e. Hospital, Clinic):

If Education, please describe the type of school (i.e. Primary/Secondary/University):

If Other, please describe:

What type of Environment is your project in?RuralUrbanUnderserved UrbanSuburban

Describe the area or community where the Project will take place. Please mention any community support or challenges:

FINANCIAL SUSTAINABILITY QUESTIONS:

How long has your organization or Group been active?

Is Your Organization Registered with the Corporate Affairs Commission?YesNo

If "Yes", please List the Registration Number:

Has Your Organization Paid Taxes Recently?YesNo

Please provide operational costs for the business (break revenue streams and costs into larger categories) for the prior year:

YEARLY INCOME:

• Revenue Stream 1:

• Revenue Stream 2:

YEARLY EXPENSES:

• Category 1:

• Category 2:

GENERAL QUESTIONS:

Provide an explanation of how your program aligns with PSDDA's vision and how your project will benefit the local community that you seek to support:

What Social Impact has the organization provided in the past to this or other local community?

Please share your success stories or past community impacts and list any prior donors or grants you've received:

Is there anything else you would like to share about yourself or the recipient that might help PSDDA in making a decision?

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