ASSHF Application Form
ASSHF Application Form
U.S. AMBASSADOR'S SPECIAL SELF-HELP FUND
Please be aware that submitting a grant application to the U.S. Embassy does not guarantee a grant award. Each year, we receive far more project proposals than we can fund. In order to create a competitive application, please pay close attention to our funding criteria, and complete the grant application in as much detail as possible.
If you are awarded a grant, you will be responsible for accounting and administration of the project. Your group will order and procure all goods. Payment is made by the Self-Help Office after goods or services have been provided by direct payment to vendors based on a final invoice, or by reimbursement to you for payments you have made on behalf of the project with your own money. We do not provide cash advances, so you must obtain a final invoice. Payments are made via direct deposit from the U.S. Embassy to the appropriate bank account.
The U.S. Embassy funds a variety of projects each year, with an objective to obtain geographical diversity in project selection. Projects for which women and girls are the primary beneficiaries are encouraged. We do not consider projects that benefit a small number of individual(s). Please keep in mind that our total funding for 2011 projects was $50,000, so keeping your budget well under $10,000 will make your proposal more competitive.
Examples of Acceptable Projects:
- Construction - community centers, school blocks, health facilities, libraries, and bridges
- Water - wells, latrines, pumps, boreholes, dams, drainage systems and irrigation systems
- Durable Equipment - desks, chairs, laboratory equipment and library items
- Income-Generation - fishponds, oil presses, weaving looms, brick-making machines, agricultural machinery, tools for furniture making and agri-business projects.
- Environmental - wildlife conservation projects, tree planting/nurseries, renewable energy projects (fuel efficient stoves, biogas, or briquette making).
- Other - multi-sectoral combination of the above.
Self-Help Project Criteria:
- Projects should aim to improve the basic economic and social conditions of the village or community and should benefit the greatest number of people possible.
- The project initiative should come primarily from community action, but it can be sponsored and assisted by institutions, associations, government, or other sources outside the community.
- Projects must involve a self-help contribution of labor, material, and/or money freely given by members of the local community. This contribution should be worth at least 25 percent of the total project value. Failure of the community to provide their stated contribution will result in immediate termination of the agreement. Contributions by government entities are not considered to be community contributions.
- The community must be able to operate and maintain the project over its intended life. The U.S. Government's support for the project must be a one-time-only contribution.
- Projects must be completed within one year.
Elements of Successful Projects:
- Pre-established long-term goals and a coherent plan to keep the project running in the future
- Presence of a capable project manager who is a long-term resident in the community.
- Assistance of a non-biased umbrella organization, such as a religious mission or a local NGO that will provide guidance and arbitration on issues when necessary.
- Coordination and communication amongst the grant-recipient group, local leaders, and local government representatives.
- Use of materials and supplies that can be maintained by the community, and the use of materials that will not harm the environment.
• Religious activities
• Refugee assistance
• Personal business
• Police or military projects
• Recurring expenses such as salaries and scholarships
• Motor vehicles
• Office supplies
• Sports equipment
• Drugs, fertilizers, and pesticides
• Remodeling or renovation due to lack of maintenance
• Revolving loan funds and seed money
• Overhead, or other administrative costs
• Funds cannot be commingled with funds from other donors.
U. S. AMBASSADOR’S SPECIAL SELF-HELP FUND
Application for Financial Assistance
1. Name of Project:
2. Type of Project:
- Income Generating
- Other (specify)
Does this project involve the construction of permanent buildings? Yes No
3. Location of Project: Include a small map showing exact location.
Region District T. A. Village(s)
4. Sponsoring Organization or Agency:
5a. Project Contact: This is usually the person who will serve as the Project Manager.
5b. Will this person serve as the Project Manager? Yes No
If not, who will?
6. What local committee or agency will supervise this project?
When was this committee formed?
Other activities conducted by this committee?
7. Who will manage the budget and buy the materials/equipment?
Name & Organization:
8. Describe the Project: Include a short description of what the project entails, exactly what you will do with the funds, and a brief explanation of why this activity would be useful to the community. Attach anything necessary to explain the project, such as building plans, specifications of equipment, photos, maps, drawings, etc.
Estimated Starting Date:
Estimated Date of Completion
9. Sustainability Plan: Briefly state what will ensure your project’s success.
10. Has this project ever received funds from any U.S. or other donor?
If yes, state date, amount received, name of donor and item(s) funded:
11. Has this proposal been submitted elsewhere for possible funding? Yes No
If yes, state the name and contact address of the organization(s) or donor group(s):
12. Is a Peace Corps Volunteer associated with this project?
Yes _____ No _____
If yes, name the Peace Corps Volunteer:
13. Is a Member of Parliament associated with this project?
If yes, name the M.P.:
14. Who are the beneficiaries?
Estimated number: Male Female Total
15. Value of Local Contributions: List the estimated value (MK) next to materials or services that your community will give to the project. Do not include items that would be financed by the Ambassador’s Special Self-Help Fund. Include items such as bricks, sand, stones, timber, land, food and training.
Items (Materials / Services)
Value of Self-Help Unskilled Labor:
Value of Self-Help Skilled Labor:
Cash Contributions: MK
Source of Cash?
16. Total Community Contribution: MK
17. Items and Expenses to be Financed by the Ambassador’s Special Self-Help Fund: Quote actual prices at the time of application (MK). It may be helpful to consult vendors for accurate materials lists, quantities, and prices.
Items (Materials / Services)
If you require additional space to list materials/services, list items on a separate attached page.
Total Cost of Materials & Services: MK
18. Financial Calculations:
A. Value of Local Contributions: MK
(Bring forward the total from item 16)
B. Cost of Other Materials and Services: MK
(The total from item 17 = amount of grant request)
C. Total Cost of Project: MK
(A + B = Total Cost)
D. Percent of Project Contributed by Community:
(A / C = %) MK
19. Grant Request: MK
(Should equal total from item 17)
20. Please enlist the support of at least two local authorities: For example, Traditional Authorities, Chief Executive Officer/District Commissioner, Community Development Assistant, Member of Parliament, etc. The authorities should be appropriate to the kind of project being proposed. These signatures indicate that the authorities:
1) Are informed of the plans in this proposal;
2) Approve of these plans;
3) Attest that it is a valid plan put forward by a legitimate organization; and
4) Are pledging their support to the project.
Local Authorities Recommending the Project:
1) Name (please print clearly)
2) Name (please print clearly)
3) Name (please print clearly)
Important: Applicants are requested to send their application by only one means (do not email and send through the mail). In the interest of making the most cost effective use of resources, we are only able to respond to applicants whose project proposals are short-listed for pre-selection site visits. Applicants who do not receive any feedback from the Self-Help Office within three months should consider their applications unsuccessful.
Send Application, Map and Directions To:
AMBASSADOR’S SPECIAL SELF-HELP FUND
EMBASSY of the UNITED STATES of AMERICA
P.O. BOX 30016