2012 Citi Foundation International Grant Application Form

Transcription

1 2012 Citi Foundation International Grant Application Form ORGANIZATION'S GENERAL INFORMATION General Information Official, legal name of the organization (in English) Official, legal name of the organization in local language (if not English) Acronyms or other names by which organization is known If the organization name has been changed within the past 5 years, please provide the former name Street Address Guidance: Please provide the organization's full street address, including city, postal code and country. Telephone Number Website Address Number of full-time paid employees at your organization Name and title of Chief Executive Officer (CEO, President, Executive Director, etc.) Name and title of Financial Officer (Director of Finance, Chief Financial Officer, etc.) Name of Chair of Governing Board Name, title and address of the person authorized to sign legal documents on behalf of the organization

2 Organization's Financial Information Organization's Fiscal Year End Date Month Year Annual Operating Budget What is your organization's total annual operating budget for the current year in U.S. dollars? (Whole numbers only. Include commas.) For what year is your most recent, completed financial audit? This audit should have been completed in at least 2010 and should be the audit attached to this request. What were reported revenues as they appear in the attached audited financials? If your audited financials are in local currency, please respond in local currency. (Whole numbers only. Include commas.) What were reported expenses as they appear in the attached audited financials? If your audited financials are in local currency, please respond in local currency. (Whole numbers only. Include commas.) What were net assets for your organization as they appear in the attached audited financials? If your audited financials are in local currency, please respond in local currency. (Whole numbers only. Include commas.) What were liabilities for your organization as they appear in the attached audited financials? If your audited financials are in local currency, please respond in local currency. (Whole numbers only. Include commas.) Please provide an explanation if your organization has excessive liabilities, if expenses exceed revenues, and/or if there are any legal or fiduciary issues highlighted in the auditor's notes. 2

3 Does your organization have less than 5 donors? Please provide your organization's top 5 donors (public and/or private) Include the donor names as well as the amount received in U.S. dollars by each donor in If your organization has less than 5 donors, please provide a full list of your donors here. Prior Citi Foundation Funding A) Has your organization received Citi Foundation* funding in the past? *Please note that the Citi Foundation recommends organizations for funding to partner organizations, such as United Way Worldwide, who are responsible for grant oversight throughout the terms of the grant agreements. B) If your organization was funded by the Citi Foundation in 2011 and you have not yet submitted an online interim report, please provide below the grant amount, project title, a brief description of the funded program and an explanation as to whether you are on track to achieve the expected results, otherwise please enter N/A Please note that your response should be 150 words or less. You will not be able to submit your application if your answer exceeds 150 words. Example: In 2011, we received a $60,000 grant from the Citi Foundation for the Small Business Development Program, which will provide $400,000 in direct investment for the establishment and growth of at least 40 small businesses and provide technical assistance to at least 100 microentrepreneurs in the U.K. Four months into the grant period, we have provided services to 40 entrepreneurs and are on track to achieve our expected results by the end of the grant period. These individuals have benefited from up to ten hours of technical assistance as well as a business-to-business networking event. In addition, we approved a total of 15 microloans, totaling $121,000 in direct investment for the establishment and growth of local small businesses. Thus far, a total of 6 small businesses have been established as a result of this program Organization's Contact Information Name of Primary Contact: The person who should be contacted for further information regarding this grant request. Prefix First Name 3

4 Middle Name Last Name Position Title Telephone Number Address Name of Secondary Contact Prefix First Name Middle Name Last Name Position Title Telephone Number Address 4

5 Organization's Registration Information Country of Government Registration Please provide the name of the country in which your organization is incorporated or registered. In what year did the organization register with local authorities? Which government department or municipality registered the organization? What is your organization's registration number? What is the official status of the organization (i.e. nongovernmental, government organization or for-profit company)? Organization's Governing Information What is the organization's main purpose (as it is stated in the bylaws)? What are the various governing bodies of your organization? Describe their roles and be certain to include information about your Board of Directors. How is the Board of Directors elected? What is the Board composition (how many members; committees; terms of office)? How often does the Board of Directors meet? Do Board members receive a monetary compensation for their work as Board members? If yes, please 5

6 include how much each Board member receives. In case the organization is dissolved, how would the organization's assets be distributed and who would be the recipients? 1. Specify Program Start Date Program Overview Guidance: Indicate the date that you will begin to use the funds from the requested grant, please take into account grant processing time (approximately 90 days from submission date). Note that the Citi Foundation requires the grant funds to be used within a 12-month period. Grant funds cannot be used retroactively Month Year 2. Grant Amount Requested Guidance: Indicate the amount in U.S. dollars that you are requesting from the Citi Foundation as agreed upon by your Citi Contact. This must equal the dollar amount stated in the required program budget template. Please round off to the nearest thousand U.S. dollars. 3. Overall Program Budget Guidance: Indicate the overall budget for this program in U.S. dollars. Please round off to the nearest thousand U.S. dollars. 4. Program Title Guidance:: Please indicate the title of the program for which you are requesting funding. The title should be no longer than 7 words and end in "project", "program" or "initiative" Example: Client Financial Capability Program 5. Focus Area for the Program Guidance: : Using the drop-down box below, select the primary Citi Foundation focus area to which your program clearly contributes. If you are uncertain, please ask your Citi Contact. 6

7 6. Program Summary Statement Guidance: : Please provide a brief description of the program for which you seek support, including the overall goal and impact of the program, how Citi Foundation funds will be used, and the geography served by the program. Please limit your description to no more than 5 sentences. Example: The Client Financial Capability Program will provide low-income families in the East London neighborhood of Tower Hamlets one-on-one financial counseling and financial education. The program will improve the financial behaviors of participants, which will result in at least 450 of the 600 that sign up for the program opening a savings account or reducing debt by at least 15% and, of these people, at least 250 increasing their saving by up to 20%. Each participant will receive a financial assessment, education and coaching to develop a plan to improve their financial situation. Citi Foundation funds will be used to purchase program materials and support staff time for financial counselors and educators who will coordinate, manage, market, implement and evaluate individual counseling sessions and courses. 7. Indicate the Geographic Area(s) Served by the program where Citi Foundation funds will be used and the percentage of funds utilized in each area. Guidance: Select the country (ies) from the available list and note the corresponding percentages beside the appropriate country. You may enter up to 5 countries. If your program serves more than 5 countries, please select "Other" as the fifth option and list the additional countries in question #8. 8. If you selected "Other" in question #7, please list the additional countries along with the corresponding percentages. 9. Primary Population Served Choose one of the following: 10. Gender of Population Served Choose one of the following: Your Organization 11. Describe your organization's overall mission and expertise and how it relates to the program for which you are requesting funding. Guidance: We are looking to understand what your organization does especially well. This may include four elements: 1) Knowledge - your organization's unique insight into participant barriers and opportunities; 2) Skills - what your 7

8 organization knows how to do; 3) Change agent - how your organization uses its skills and knowledge to influence others to change their behavior or condition and; 4) Experience - length of time and track record in the proposed program area. Be as specific as you can and include what impact your organization has had in the program area for which you seek our support. Please note that your response should be 300 words or less. You will not be able to submit your application if your answer exceeds 300 words. Example: Since the organization's inception in 2000, we have concentrated our efforts on delivering high quality financial counseling, coupled with financial education and access to other resources that contribute to financial stability. Our mission is to help individuals and families achieve their financial goals through comprehensive financial capability programs. In the last 6 years, we have worked with over 10,000 low-income individuals to stabilize their financial situation and build savings. Over 60% of our program participants report an increase in their savings and a reduction in their expenses within 3 months of the program's end. Our ability to form strong partnerships with NGOs, government and businesses around the area of financial capability has been essential to our success. Today we boast a network of over 100 partners working in Tower Hamlets in order to serve and address the needs of this community. Earlier this year, Finance UK was the leading voice in a consortium of NGOs, advising the UK government on the social services and educational need of East London residents. Our role within the consortium has enabled us to visit and advise various government offices. As a result of our work, we have been commissioned by Tower Hamlets to train front-line counselors on financial education and counseling. Target Population / Your Participants 12. What is the issue or opportunity you want to address? Guidance: Please provide detailed information including local socioeconomic and demographic data that explains both the issues in the community that support the need for this program as well as how these issues are impacting the lowincome individuals, communities, organizations or micro and small businesses that you plan to serve through this proposed program. Example: The Office of Budget Responsibility (OBR) predicts that household debt in London will increase substantially in the coming years. Based on an evaluation of annual debt and payment performance data, CallCredit, a Leeds based credit reference agency, ranked East London as one of the most indebted regions in the UK in Specifically, in Tower Hamlets, which has high levels of unemployment and one of the highest population densities in London, more than a quarter of households have incomes below 15,000. Limited understanding of the complex financial system and a lack of basic financial skills has led to these increasing levels of debt for low-income residents. Education on how debt and savings affect their life choices is necessary for them to make more responsible choices and to ensure that they do not remain in a cycle of poverty. 13. Your Participants A) Who are your participants? Guidance: Describe the individuals, micro and small businesses and organizations with which you will work during this program. Include detailed information, including, if appropriate, age group and socio-economic status and what standards are you using to determine the socio-economic status of the participants. 8

9 Example: The population we plan to serve through the Client Financial Capability Program are adults in Tower Hamlets, between the ages of 40 and 75, that have an urgent need and a strong desire to improve their financial behaviors so that they build assets and stabilize their financial situation. They will typically face a number of barriers to effective money management and planning - lack of confidence and skills in budgeting, limited saving and asset planning for the future, lack of awareness of financial products and limited knowledge of their options. Individuals served will be low-income - with annual incomes under the poverty line according to the UK index. B) What percentage of the population served by this program is low-income as defined by local standards and definitions? (Whole numbers only. DO NOT enter a percent symbol or decimals.) 14. Participant Type A) How many participants do you plan on serving during the grant period? B) How many micro or small businesses do you plan on serving directly during the grant period? Be certain to include both new and existing businesses. C) How many organizations (i.e. microfinance institutions, community development organizations, etc.) do you plan on serving directly during the grant period? Example: 600 Your Results 15. Please provide a summary results statement. Guidance: Please indicate the participant results that you expect to achieve during the 12-month duration of the requested grant. The fact that the participants in your program have completed the activities you implemented, read your materials, and sat through counseling or a workshop is not the result. The results we are referring to are the changes in the behaviors or conditions of your participants based on what you offered to them. This distinction is critical. Please do not focus on activities, programs implemented or levels of participation satisfaction. For additional reference materials for defining your program results, please click here. 9

10 Please note that your result statement should be 100 words or less. You will not be able to submit your application if your answer exceeds 100 words. Example: By December 31, 2012, 450 of the 600 participants in the program will improve their financial behaviors by learning to use and maintain a budget for at least six months after the program is complete; reducing debt by at least 15%; and/or opening a savings account. At least 250 of these participants will also increase their savings by up to 20% within the grant period. 16. Please provide some additional detail regarding your proposed results. Guidance: In each of our focus areas, there are specific results that will help us to better understand the impact of each investment. For the specific focus area to which you are applying, please respond to all questions that apply to your program. Complete the questions that reflect the results you expect your participants to achieve during the grant period. Note that participants may achieve more than one result within a grant period and therefore, it is possible that the sum of your entries may equal or exceed the number of participants served. If your program participants will demonstrate results in more than one focus area, complete those questions as well. Example: How many individuals will be able to demonstrate financial knowledge and skills as a result of this program? 500 How many individuals will change and maintain changes to their financial behavior as a result of this program? 450 How many individuals will build financial assets as a result of this program? 250 How many individuals will preserve financial assets as a result of this program? 0 How many organizations will be better able to provide services to clients as a result of this program? 0 For Financial Capability & Asset Building programs: How many individuals will be able to demonstrate financial knowledge and skills as a result of this program? How many individuals will change and maintain changes to their financial behavior as a result of this program? How many individuals will build financial assets as a result of this program? 10

11 How many individuals will preserve financial assets as a result of this program? How many organizations will be better able to provide services to clients as a result of this program? For Microfinance programs: How many new financial products will be developed as a result of this program? How many consumers will use financial products to help meet basic needs or create a financial safety net as a result of this program? How many microfinance organizations will be better able to provide services to clients as a result of this program? For Enterprise Development programs: How many new jobs will be created as result of this program? How many micro or small enterprises will be created, improved or expanded as a result of this program? 11

12 For Youth Education and Livelihoods programs: How many youth will be able to demonstrate the new skills that they have obtained through training and support as a result of this program? How many youth will gain employment as a result of this program? How many youth will start a business as a result of this program? How many youth will enroll in postsecondary education as a result of this program? How many youth will obtain a postsecondary degree as a result of this program? How many organizations will be better able to provide services to youth as a result of this program? 17. How will you know when your results have been achieved? What data will you use and how will you capture this data in order to track successes and make course corrections in your program? Guidance: Please explain how you will confirm that participant results were achieved, how you will collect this information and how you will use the data to keep participants on course to the result. Keep it as simple as possible and look to methods that are low effort and low cost. You may be able to use existing data sources or rely on existing measurement instruments. Alternatively, you may be able to use observations and reports by others and in some cases self-reported behaviors. 12

13 Example: Participants will complete an assessment of their financial knowledge and behaviors prior to and after the program is complete. We will be measuring key changes to participant debt levels and savings. During the course of the program, counselors will evaluate participants' progress at monthly sessions to help them identify any specific improvements that would help them achieve these goals. Once the participants have completed the program, counselors will then review the pre- and post-program questionnaires to ascertain the improvement in the financial knowledge of the participants and the proposed changes in their financial behavior. At the end of the program, we will engage a team of graduate students to evaluate the data and program results and recommend improvements for next year. Your Program 18. What are the key elements of your program that are critical to achieve the stated results? Guidance: Most programs are not a random set of activities. They are a coherent strategy to achieve a result. Tell us the key elements of your program that must be in place for you to succeed with participants. You may wish to group elements/activities together in relation to the planned results for clarity. Example: Building financial skills and changing financial behaviors: Participants begin the program with a one-onone counseling session to identify their current status and to establish short- and long-term financial goals. Participants then meet with counselors monthly for on-going financial counseling as they implement changes in financial behavior. Participants supplement counseling with at least 3 months of financial education courses that include modules on Basic Banking and Banking Services, Money Management and Budgeting, Saving and Investing, and Credit and Spending. Throughout the program, staff will provide opportunities to extend the learning process by connecting and integrating with other affiliate programs, including providing participants with referrals (for example, to adult continuing education programs to increase earning potential), online materials and peer-to-peer support. Curriculum development and outreach: We will be working with local government authorities and at least 10 community groups as part of our strategy to introduce the community to the program. We will also update the financial education curriculum to reflect recent changes in the country on opening a savings account and design a new interactive video on money management that will be integrated into our course. Monitoring Program and Verifying Results: Program counselors evaluate participants' progress toward financial goals during monthly counseling sessions. Participants also receive post-program surveys 3 and 6 months after completing the program. 19. How much interaction is required for participants to achieve the proposed results? Guidance: The frequency and duration of your interactions with participants should be consistent with the result you want them to achieve. Please clarify the amount of time and frequency you will interact with your participants while in your program. Example: Participants will receive a minimum of 9 monthly/ 2-hour one-on-one financial counseling sessions and 3 months of financial education. Each of the four financial education courses lasts on average of 1.5 hours. Participants 13

14 are also encouraged to supplement sessions with peer-to-peer support, online materials, and additional support from partner community agencies. 20. Describe the critical activities you will implement, the milestones you anticipate achieving from each activity, and a timeline. Guidance: We do not need a list of every activity you will undertake, but are looking for major activities that will help you achieve your stated results. Our intent is to get a sense of the work it will take to achieve your results, the specific participant milestones that will be achieved during the grant period and timing to get to your results. Please ensure that the timeline you provide covers the entire 12-month duration and clearly denotes the month for each milestone. Example: Activities: 1) Conduct outreach to introduce the community to the program. 2) Enroll potential participants in the program. Milestone 1: 600 participants sign up for their first financial counseling session (Month 1). Activities: 3) Conduct monthly one-to-one financial counseling sessions 4) Conduct financial education courses 5) 500 participants attend initial sessions and courses and develop a financial plan based on individual counseling received and course learnings. Milestone 2: 500 participants submit a complete financial plan (Months 2-5). Activities: 6) 450 participants attend remaining monthly financial coaching sessions as they implement their plan. Coaches track progress and evaluate client outcomes using pre- and post-program questionnaires. Milestone 3:: 450 participants demonstrate changes in behavior by using and maintaining a budget for at least six months after the program is complete; paying down debt; and/or opening a savings account and at least 250 of these participants increase their savings. (Months 6-12). Activities: Analyze data on client results and identify at least one change in program to improve participant outcomes. Milestone 4: Implement change in program to increase the number of participants in the financial counseling program that succeed in achieving results (Month 12). 21. If you are working in multiple sites or with subcontractors, how will you ensure that your program activities are being implemented and your budget is being spent according to plan? Guidance: Include how you will monitor how the program is being implemented. For example, will you have regular monitoring visits to project sites and/or regular progress reports? Please be specific. Example: We will have bi-monthly meetings with all educators and counselors to assess how their projects are going, and to share best practices on what works and does not work. Our Program Director will review each component of the program to confirm that the content is being delivered and received successfully. Key People and Groups 14

15 22. Who is the person that will lead this program? Guidance: Explain why the person leading this program or effort is most qualified to achieve the results you seek, providing information on the person's areas of responsibilities and past successes with similar programs. If success of this program is dependent on a person's training or education, please be certain to explain the relevance. Example: Mark Smith, Program Director, is overseeing this program and has been doing so for the last 3 years. He specializes in behavioral economics and has produced extensive research on the topic. He has contributed to a number of publications and presented at convenings around the financial capability of low-income individuals. 23. Are any partners or intermediaries critical to the program's success? Guidance: Name the partners or intermediaries and describe the relationship that your organization has with these partners. Include information on why these partners or intermediaries are needed for the program. Example: We are pleased to work with the National Network for the Promotion of Financial Coaching (NNPFC), which has committed to provide our staff with annual training in financial counseling and keep us informed of new developments and innovations in the field that we can incorporate into our work. We have worked with NNPFC for the past ten years and have just recently signed a 5-year contract with them ensuring that they will continue to provide the training to which they have committed. Program Visibility Additional Information 24. How will this program be communicated to the public, professional peers and thought leaders? Please be specific and include such detail as press releases, convenings, web postings, brochures or other related materials. 25. Will this program include publication of any reports and/or research white papers? If yes, when is this report expected to be produced? If known, please specify the anticipated title of the publication? Citi Engagement 15

16 26. Will Citi employees participate/volunteer in this program? If yes, please indicate how many and describe in what capacity. Guidance: Please note that, although we encourage the engagement of Citi employees in Citi Foundation funded programs, the involvement of Citi employees is not a determining factor for funding consideration. 27. Is there a Citi employee on the Board of the organization? Guidance: If there is a Citi employee on the Board of your organization, please provide the Citi employee's full name, Citi business, and title as well as board position and/or whether the Citi employee serves in an advisory capacity regarding the finance, governance or fundraising for the organization. Please note that the involvement of Citi employees is not a determining factor for funding consideration. Citi Contact Information 28. Citi Contact Name Guidance: Provide the name of the Citi Contact who invited your organization to apply for a grant as it appears in the Invitation to Apply . Do not include title or address. 29. Grant Program Guidance: Please select the appropriate grant program based on the instructions provided in the Invitation to Apply e- mail sent by your Citi Contact. By checking this box, I verify that my Citi Contact has reviewed this application and has provided authorization to submit this application for consideration by the Citi Foundation. I understand that submission of an application does not constitute an offer, promise or guarantee of funding from the Citi Foundation, Citigroup Inc., or any of its subsidiaries. Please note that the existence of any current or the promise of any potential business relationships with Citi or Citi subsidiaries do not influence grant decisions and mention of such relationships may disqualify your grant application. The Citi Foundation declines any tangible benefits your organization might decide to give to Citi or the Citi Foundation as a result of a grant. The Citi Foundation works with partner organizations such as United Way Worldwide to support philanthropic initiatives outside the United States. These organizations will require additional information and documentation from you once the Citi Foundation has recommended the grant to them. The partner organization will make the final approval decision for the grant and will have oversight responsibility throughout the grant term. 16