ВЫХОД

Eurasian Coalition on Male Health

Regional Program "Rights to Health" 2019

APPLICATION FORM

Competition for the selection of sub-recipients

Part A. General Information

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* 1. Name of the organization
As shown in the organization’s registration certificate (in English and/or in Russian)

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* 2. Country where the organization works

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* 3. Legal address of the organization

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* 4. Postal address of the organization (if different)

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* 5. Phone number

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* 6. E-mail

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* 7. Web site

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* 8. Head of Organization

First Name, Surname

E-mail

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* 9. Project Coordinator

First Name, Surname

E-mail

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* 10. Accountant

First Name, Surname

E-mail

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* 11. Proposal components NGO applies for

Advocacy for sustaining services for gay men and other MSM communities

Advocacy for sustaining services for trans* people communities

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* 12. Total requested sum in EURO

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* 13. Organization’s objectives and major areas of work:

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* 14. Is the organization community-based? Are there representatives of gays or bisexuals and other MSM and trans* people among the members of the organization, board, management and staff?

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* 15. Was organization implementing similar projects/activities targeting MSM and trans* people in the past? Describe dates, goals and the results achieved (up to 300 words)

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* 16. Key partners of the organization (both NGOs and public facilities)

Part C. Project description

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* 17. Description of major achievements and challenges from the first stage of the project implementation (January-December 2017)*

* Only for NGOs that are current subrecipients under the ECOM’s Regional Program “Right to Health”

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* 18. Description of the problem that organization wants to address and target groups

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* 19. Project goal and objectives

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* 20. Short description of national advocacy plan (main objectives and activities)

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* 21. Project implementation strategy and workplan, including activities for national advocacy plan implementation (up to 2 pages)

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* 22. Expected results

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* 23. Project’s sustainability strategy in long term perspective

Part D. Matrix of indicators

Project’s expected results

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* 24. Result 1

Expected result

Indicator

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* 25. Result 2

Expected result

Indicator

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* 26. Result 3

Expected result

Indicator

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* 27. Result 4

Expected result

Indicator

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* 28. Result 5

Expected result

Indicator

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* 29. Result 6

Expected result

Indicator

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* 30. Result 7

Expected result

Indicator

Part E. Key staff
(provide first and last name, short professional experience)