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Small Grants Facility for Conservation and Development in the Succulent
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                                                            ANSWERS IN THE FORM OF TEXT or TICKS.
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                                                             ANSWERS IN THE FORM OF TEXT or TICKS.
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                                                             ANSWERS IN THE FORM OF TEXT or TICKS.
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                                                                    ANSWERS IN THE FORM OF TEXT or TICKS.
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      PART 6: Give a 2-5 page description of your proposed project including the following
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                   PART 7: HOW DO YOU PLAN TO DO PROJECT AND WHAT YOU PLAN TO DO
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         4.   List the source/s and amount/s of any other funds or in kind donation already obtained,
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2 Skeppies Application Form Version 2008 09 September 11

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Steven Davids, Skeppies Fund, Application Form, South Africa

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2 Skeppies Application Form Version 2008 09 September 11

  1. 1. 1 Small Grants Facility for Conservation and Development in the Succulent Karoo A partnership project between CEPF, DBSA, CI, and SKEP c/o Kirstenbosch Botanical Garden Private Bag X7 Claremont, 7735 SOUTH AFRICA Tel: +27-21-799-8852 Fax: +27-21-762-6838 Cell: 073-843-2702 Website: www.skep.org Email: s.davids@conservation.org Application Form and its Guidelines • It is always best to first contact the SKEPPIES project team and discuss your idea with them. They can tell you if your project fit our criteria and funding portfolio’s and can guide you to give your application a better change of success. • Please complete all the questions to the best of your ability as this will speed up your application. • If you do experience any problems in filling out this application form, do not hesitate to contact us at the above address because we regard our applicants as future partners and are here to help you. • You may use a pen to fill in the form, but the completed application form must be submitted in electronic format as this will help distributing it among our panel of reviewers. Should you not have computer facilities or email, please contact us so that we may assist you in this regard. • When submitting this form, please ensure that letters of support from all project partners are included. • Send or email the completed application to our supplied address. • Please bear in mind that the funding application procedure takes time. We generally try to provide feedback within 14 days of submission. However, we are the process of moving over to a quarterly project selection process. • The application form may also be completed in Afrikaans. • All applications must be accompanied by a visual application using digital photos. Examples of these are provided. • All successful applicants must at least attend one anchor project exchange forum meeting to inform other’s of their project. This cost must be budgeted for or else the applicant must carry this out of his own pocket.
  2. 2. 2 ANSWERS IN THE FORM OF TEXT or TICKS. QUESTIONS Use only this column for your answers. PART 1: GENERAL 1. Project Title 2. Total amount you applying for. This amount must not exceed R 140,000 per application per annum. 3. Give a one paragraph description of your project. Use only the space provided: 4. Date of application 5. Duration Do not write in this block 5.a. Enter the estimated date the project will start 5.b. Enter the estimated date the project will end. 6. Please give the GPS coordinates of the location of your project. Many new cell phones have this function. If you do not have it or know what this Do not write in this block is, your SKEPPIES project developer will assist you with this. 6.a. South 6.b. East 7. In what SKEP area is your project located (please Do not write in this block tick)? 7.a. Western Cape 7.b. Northern Cape 7.c. Both Western & Northern Cape 8. In what SKEP area is your project located (please Do not write in this block tick)? 8.a. Bushmanland 8.b. Klein Karroo 8.c. Hantam-Tanqua-Roggeveld 8.d. Knersvlakte 8.e. Namaqualand Coastal 8.f. Namaqualand Uplands 8.g. Greater Richtersveld 8.h. Central Breede River Valley 8.i. Biome Wide (or more than 2 hotspots) 9. Has your project proposal been examined by the relevant SKEP Priority Area Projects Forum. Only answer YES or NO. If not, the proposal may be reviewed by local experts and revisions may
  3. 3. 3 ANSWERS IN THE FORM OF TEXT or TICKS. QUESTIONS Use only this column for your answers. be requested 9.a. If Yes, at give a date of the meeting and a copy of the decision. 10. Which ONE of the following SKEPPIES funding directions for conservation does your project Do not write in this block link to? PLEASE TICK THE ONE ASPECT that describes your project best. 10.a. Biodiversity-based businesses 10.b. Environmental “Best Practices” in agriculture 10.c. Environmental “Best Practices” in mining 10.d. Establish a protected area 10.e. Restore degraded land in key biodiversity area 10.f. Tourism activities 10.g. Biodiversity education within the context of the project 11. The National Strategy for Sustainable Development identifies various priority areas for strategic intervention. The document is available on the website http://www.environment.gov.za Motivate which ONE of the following SKEPPIES Do not write in this block funding directions for development your project will contribute to. Use only the space provided. PLEASE USE ONLY THE ONE ASPECT that describes your project best. 11.a. Use natural resources efficiently and sustain ecosystems. Examples of these projects are improving water, air, soil quality; waste management; climate change; food security, and ecotourism. 11.b. Creating sustainable green communities. Examples of these projects are green buildings; green procurement; energy and watersaving; and the recycle of solid and liquid waste. 11.c. Enhancing systems for integrated green planning. Examples are projects that redefine development projects (the IDP's and SDF's) to be ecosystem and resource enhancing rather than environmentally destructive. 11.d. Building capacity for sustainable development. Examples of these projects are building the capacity local government; skills development; community empowerment; direct engagement with communities Do not write in this block 12. State the measurable DEVELOPMENT impact of
  4. 4. 4 ANSWERS IN THE FORM OF TEXT or TICKS. QUESTIONS Use only this column for your answers. your project: 12.a. Number of new businesses or ventures started. 12.b. Number of existing businesses that will get added value from the project. 12.c. Number of people involved in capacity building. 12.d. Number of people that will be reached through awareness raising. 12.e. Number of new jobs created. 12.f. Number of women empowered through project. 12.g. Number of youth that is people younger than 35 years. PART 2: State the measurable CONSERVATION impact of your project. You may not know this. Please contact your SKEPPIES project developer or someone from SANBI who will assist you with this. 1. Climate change adaptation / mitigation Do not write in this block 1.a. Is this project located within the Namaqualand Wilderness Initiative biodiversity corridor (yes / no) 2. Support SKEP ecological processes Do not write in this block 2.a. Does project support a river corridor (yes/no) 2.b. Does project support a sand movement corridor (yes/no) 2.c. Does project support a quartz and gravel Succulent Karoo corridor (yes/no) 3. Contribution towards BIODIVERSITY TARGETS Do not write in this block 3.a. SKEP Vegetation targets Hectares better Hectares managed, Vegetation type added restored, sustainably used 3.b. SKEP Plants or any Red Listed plants 3.c. SKEP Reptiles or any Red Listed (Reptiele soos akkedisse, slange, skilpaaie) 3.d. SKEP Birds or any Red Listed birds (voels)
  5. 5. 5 ANSWERS IN THE FORM OF TEXT or TICKS. QUESTIONS Use only this column for your answers. 3.e. SKEP Amphibians or any Red listed (paddas) 3.f. SKEP Invertebrates or any Red listed (98% van alle diere is invertebrate. Dit is diere sonder inwendige been soos wurms, insekte, slakke) 3.g. SKEP mammals or any Red listed (soog diere soos molle en rotte) 3.h. SKEP Fish or any Red listed PART 3: ELIGIBILITY QUESTIONS 1. Do you plan to use any of the potential project funds to purchase land? Answer YES or NO. 2. Does your project involve the removal or alteration of any physical cultural property (includes sites having archeological, paleolontogical, historical, religious, and unique natural values)? Answer YES or NO. 3. Does your project involve the relocation of people or any other form of involuntary resettlement? Answer YES or NO. 4. Do you plan to use any of the potential project funds to capitalize a trust fund(s)? Answer YES or NO. 5. Are you an international NGO? Answer YES or NO. PART 4: ORGANISATION'S INFORMATION 1. Tick off one of the descriptions below that best describes your type of organisation. All of these Do not write in this block organisations qualify for a SKEPPIES loan. 1.a. Government 1.b. Parastatal 1.c. Non-governmental organisation (NGO) 1.d. Community-Based Organisation or group (CBO) 1.e. Training, education and research institution 1.f. Individual with a good cause 1.g. Private sector (including Small and Medium Enterprises) 1.h. Networks (e.g. Environmental Education Networks) 1.i. Traditional authority
  6. 6. 6 ANSWERS IN THE FORM OF TEXT or TICKS. QUESTIONS Use only this column for your answers. 1.j. Faith based organisation 2. Name of Applying organisation 2.a. Physical address (Street name, number etc) 2.b. Town 2.c. Postal address (P.O. Box number etc) 2.d. Town of Post Office box 2.e. Postal Code 2.f. Telephone number 2.g. Fax number 3. Years that your organization has been in Operation 4. Total number of permanent staff 5. Provide a brief description of your organisation’s Mission and History. Use only the space provided. 6. Motivate in the space provided why you are the best institution/individual to undertake the proposed project. 7. Name of Main Contact Person 7.a. Cell number of main contact 7.b. Email address of main contact 8. Name of Alternate Contact Person 8.a. Cell number of alternate contact 8.b. Email address of alternate contact PART 5: FINANCIAL ACCOUNT INFORMATION Name of account holder At which bank do you have an account e.g. ABSA, FNB. Name of the Branch Branch Code What type of bank account do you have e.g. cheque, savings What is your bank account number? Does the organization have a valid tax clearance certificate? If not, please get one because if the application is approved, it is a requirement that you should have one in order for the money to be paid over to you.
  7. 7. 7 PART 6: Give a 2-5 page description of your proposed project including the following 1. Background: Why you want to do the project? In other words what problems and issues do you want to address or what opportunities does your project want to take advantage of? 2. What do you want to do? In other words how does your project plan to address the issues and opportunities; or solve the problems that were identified in the previous question? 3. Clearly state what the CONSERVATION impacts are your project will achieve. Remember, your project must have both a development and conservation aspect. 4. Clearly state what the DEVELOPMENT impacts are your project will achieve. Remember, your project must have both a development and conservation aspect. 5. Where do you plan to do it? In other words in what villages, towns, municipal areas, etc? 6. What potential problems do you think you 7. How do you plan to overcome these problems? might encounter in your project? 8. Who will benefit from your project? 9. Why do you think the project will be sustainable and continue to exist when the SKEPPIES funding period ends? 10. What is the exist strategy of the project developer or champion to ensure that the project does not become dependent on him but that it will indeed be self sustainable? 11. Does your project link with other projects, and in particular with other SKEP projects? What value does it get from or add to those projects?
  8. 8. 8 PART 7: HOW DO YOU PLAN TO DO PROJECT AND WHAT YOU PLAN TO DO How do you plan to do the project? In other words name the major phases of your project and describe what you intend doing in each phase. How long you think it will take to reach each phase. Please set this information out in table form as illustrated below. Measurable out Phases Main Activities Timeframes comes PART 8: PROJECT BUDGET AND PARTNER INFORMATION 1. Why do you apply specifically to SKEPPIES for funding for this project? 2. Did you apply to other organizations for financial funding for this project? 2.a. If you did not apply, what are the reasons. 2.b. If you did apply, what are the names of the organizations, for what amount did you apply and what was the response of the organization? Amount you Name of the organization the response of the organization applied for 3. Give an outline of how you plan to spend the project money. ITEM COST Visit to local Anchor project exchange forum to inform them of project SUBTOTAL:- COST OF PROJECT CARRIED BY APPLICANT
  9. 9. 9 4. List the source/s and amount/s of any other funds or in kind donation already obtained, or for which you have applied for this project. NB: Please attach letter/s from partner organisations stating HOW they support this project. COST (if organization gives in kind donation, where Summary of how it Contact Details Organisation possible, give a supports the project. (E-mail / Tel / Fax,) reasonable estimate of the value of the in kind donation) SUB TOTAL: COSTS OF PROJECT CARRIED BY PARTNERS PART 9: OFFICIAL USE – NOT TO BE FILLED IN BY APPLICANT Risk Category PART 9: OFFICIAL USE – NOT TO BE FILLED IN BY APPLICANT (Questions and inputs from panel and applicant’s responses to them. To form part of contract) __________________ ___________________ Signature of applicant Date

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