What
Who
How
What
Who
How
Application Form
Application Form
Please fill in the invite only application form below.
Step 1 of 8
12%
1. Applicant Information
1.1 - Organisation Name
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1.2 - Organisation Address
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1.3 - Incorporated in the US
Yes
No
If yes, EIN
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1.4 - Primary Contact (Name and Position)
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1.5 - Primary Signatory (Name and Position)
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1.6 - Amount requested from Risk Pool Fund
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2. Project details
2.1 - Nominating Funder
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2.2 - Name of Project/Grant
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2.3 - Total Grant Budget (awarded by those named in 2.1)
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2.4 - Total Project Budget (if greater than that in 2.3)
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2.5 - Project Period
Start Date
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End Date
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2.6 - Project Manager
Name
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Email
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2.7 - Location of project
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2.7 - Location of the implementation obstacle
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3. Eligibility
3.1 - What is the implementation roadblock that is placing your project at risk
Irregular and unpredicted weather event
Outbreak of conflict/disease
Expert error (miscalculation/botched survey, etc)
Equipment failure
Local partner problem
Infrastructure disruption
Fraud, embezzlement, theft
Current fluctuation; other market effects
Government policy change
Funder created obstacles (change in grant priorities/cycle etc)
4. Detailed Project Information
Please provide an executive summary of the original project as named in 2.2.
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Please describe the implementation obstacle that this project is facing. (Max 500 words)
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Please provide any quantitative MCHN metrics associated with the Grant named in 2.2. Please focus on Outcome level metrics where relevant. You may pull directly from existing documentation. (Max 200 words)
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Please provide any qualitative MCHN metrics associated with the Grant named in 2.2. Please focus on Outcome level metrics where relevant. You may pull directly from existing documentation. (Max 200 words)
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5. Risk Pool Fund Request
5.1 What is your proposed solution? Please describe what is necessary to overcome the obstacle you outlined in 4.2. (Max 500 words)
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5.2 Please describe the activity you will undertake to implement the solution you outlined in 5.1. (Max 500 words)
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5.3 Please describe what will happen if you do not undertake the activities you described in 5.2. Reflect specifically on the metrics you gave in 4.3 and 4.4 and elaborate how these will be affected if you cannot execute your proposed solution. (Max 500 words)
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5.4 Are there any longer term (beyond the life of the project) impacts of not executing the solution proposed in 5.1? (Max 500 words)
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6. Budget
6.1 Please provide a high-level breakdown of how the Risk Pool Grant Funding will be allocated. Excel attachments are acceptable; use your own budget format. If additional detail is required we will ask for it.
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Drop files here or
7. Timeline
7.1 Please describe the projected key milestones and dates to implement the solution. Attachments are acceptable; use your own format. If additional detail is required we will ask for it
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Drop files here or
8. Additional Information
8.1 Does the organisation have any reserves?
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Yes
No
8.2 Why/why not are you using your reserves for this project? (Max 500 words)
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8.2 Why not/are there plans to create one?
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8.3 What additional funds, outside of cash reserves, are available to fund this project?
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Comments
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