Monitoring and Evaluation Form for Non Governmental Organizations

Transcription

1 Monitoring and Evaluation Form for Non Governmental Organizations A. Background of Organisation 1. Name of Organisation 2. Type of Organisation (Tick where applicable) Local International 3. Physical Address 4 Postal Address 5 Address 6 Telephone Number B. Corporate Governance Details 7. Name of Director 8. Name of Country Representative(for International NGOs) 9. Names of the Executive Committee Members (For Local NGOs) Name Designation 1

2 10. Year of Registration 11. Financial Year End 12. Date of Last Submission of Audited Financial Statements 13. Date of Last Annual General Meeting (Attach minutes) 14. List organisations with which your organisation has established linkages 15. Registered Objectives (Summarise) 16. List services provided (For instance supplementary feeding, extension services) 17. Implementation Level (Specify whether urban, peri-urban or rural) City Province (s) District(s) Ward(s) 2

3 C. Programme Details 18. Programmes Implemented July 2007-June 2008 (Tick Where Appropriate) Residential Child Care Community based Child Care Pro Bono Legal services Water and Sanitation Disability Agriculture/Livelihoods Humanitarian Assistance Residential Care (Elderly) Community Care (Elderly) *Health Care/HIV and AIDS Home Based Care Animal protection Care of the environment Gender Others (specify) D. Funding Details (July 2007-June 2008) 19. Grants Received Name Source of Grant Amount Received 20. Sub-Grantees (List any sub grantees to whom funds were allocated)) Name of Sub- Grantee Amount Sub granted 3

4 Income and Expenditure Income Expenditure Balance E. Declaration of Purchased Food Items (July 2007-June 2008) Imported Food Tonnage Local Purchases Tonnage F. Declaration of food distributed (July June 2008) Food Item Tonnage District No of Beneficiaries 4

5 Number of Districts G. Outline food distribution plan (July 2008-Decemebr 2008) Food Item Tonnage District No of Beneficiaries 5

6 Number of Districts H. Declaration of local non-food purchases (July 2007-June 2008) Item Quantity Cost 6

7 I. Declaration of imported non-food purchases (July 2007-June 2008) Item Quantity Cost J. Projects Details Activity Type Amount Expended District No of Beneficiaries 7

8 K. Summary Give a brief summary of not more than 500 words describing the projects undertaken during the year under review L. Declaration (To be signed by the organization s director/country representative) I being the authorized representative of. hereby solemnly declare that the information supplied on this form gives the true account of our organization s affairs for the period under review. Any misrepresentation of facts shall hold both the organisation and me, in the capacity of my designated office, liable for any legal consequences consistent with false declaration and/or misrepresentation of facts..... Name (in full) Signature Date 8

9 Instructions 1. Ensure that the PVO number is completed on the space provided on the top left of every page. 2. Question A. Provide the organization s latest contact details. 3. Question B. 14. List other registered PVOs which you have joint projects and joint funding with. 4. Question C. * Tick Health Care/HIV and AIDS where organisation provides medical assistance in the form of drugs and/or treatment to patients. 5. Question D. Outline all the grants received during the year under review. 6. Question E. Declare all purchased food items. 7. Question F. Specify distribution of food as disaggregated for the period under review. 8. Questions H and I. Specify purchases used directly in the implementation of the project. 9. The completed electronic copy should be sent to pvo@sdf.org or pvo@zimnapforovc.co.zw The signed hard copy should be submitted to The Director,, 3 rd Floor Compensation House, Cnr 4 th /Central Avenue Harare. 10. Any inquiries please contact The Programme Officer- PVOs, office 107 Compensation House, Cnr 4 th /Central Avenue Harare. Phone or e- mail to the addresses provided above. 9