Grant Request Form Request Form (For continued projects)
NOTE: Check list of the needed documents Following documents should be prepared in Japanese. Continuing grant projects from FY2015(or FY2014) don t need to submit the documents (2)(3)(4)(6), if no changes have made on them. Those who propose a brand-new project for FY2016 must use the request form for new projects (don t use this request form) and need to prepare all documents on the check list even if the organization have received the JFGE grant in the past FYs. Documents to be submitted Number of submission Check by Organization Check by JFGE (1) The completed grant request forms, page 1 through page 5 original and 1 copy (2) (3) (4) The organization s Articles of Incorporation or equivalent bylaws A register of members who constitute the board of directors or equivalent decision-making body of the organization Organization s statement of accounts for the past three years 1 copy 1 copy 1 copy (5) Reports, photographs and other materials showing the outline of similar activities in the past three years 1 copy (6) Other background materials that provide details of the project 1 copy (7) Blank official postcard (for acknowledgement of receipt of the Application) 1 postcard (8) Power of Attorney and documents explain a relationship between an Non-Japanese organization (Applicant) and agent in Japan original
NOTE: Agent for Non-Japanese organization needs to submit forms in Japanese. Page 1 No. JFGE Grant Application Form for Fiscal Year 2016 Date: To Mitsuhiko FUKUI, President, Environmental Restoration and Conservation Agency Agent in Japan Address: Address: Name of the organization: Name of the Agent (organization) : President of the organization: Seal Name of the President: Seal Name of the Agent (individual): Seal In accordance with the provisions defined in Article 4 of the JFGE Grant Policies and Procedures, we submit our application for the JFGE Grant for our project, which we plan to carry out as described below. Description Grant program Entry Grant Regular Grant Project title Region: Project: *Please be sure to include the country name or area. **Project title should provide a clear description Project category Project type Project area Environmental conservation projects implemented in developing areas by Non Japanese NGO a. Practical activities in the environment b. Provision and dissemination of information and raising awareness Select ONE from the left. c. International conferences d. Research Select ONE from the P.11 of Guide to the JFGE Grant Program Request The amount needed for the project Total amount needed for the project : thousand JPY (FY2016) Grant amount requested for JFGE : thousand JPY (FY2016) (include Representative-related budget) : thousand JPY (FY2016) Previous JFGE Grant(s) awarded to your organization: *If your organization has previously received a grant from the JFGE, list all fiscal years for which grant was received. *For all columns, please use only the space provided. Do not use a separate sheet.
Page 2-1 (Details of the project for which the grant is requested) 1. Project Summary *Please describe the objection, effect, detailed approach (who, where, when, to whom, what) briefly. 2. Activity conducted in FY2014 3. The achievement extent of ultimate outcomes of the project
Page 2-2 (Details of the project for which the grant is requested) 4. Planned activity in FY2016 4-1. Expected outcomes in FY2016 4-2. Project plan of FY2015 and the objectives of each activities 5. Changes from the first proposal (method, schedule, expected outcomes and so on)
Page 2-3 (Details of the project for which the grant is requested) 6. Implementation schedule first FY~ third FY Contents Activity 1 Year and Month First FY Second FY Third FY 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 Activity 2 Activity 3 Total amount for the project *Indicate the activity period with (horizontal line) NOTE: Please describe the implemented activities about the past FYs.
Income Expense Page 3-1 Budget breakdown Categories Budget (1,000 JPY) Contents Funds on hand(including donations, and grants from other organizations) JFGE Grant Total Categories JFGE Grant (1,000 JPY) Funds on hand (1,000 JPY) Total (1,000 JPY) 1.Wages 2.Honorariums 3.Travel 4.Materials and supplies 5.Rental/service 6.Administrative Total
Page 3-2 Budget breakdown Categories contents JFGE Grant (1,000 JPY) Funds on hand (1,000 JPY) Total (1,000 JPY) Activity 1 1.Wages 2.Honorariums 3.Travel 4.Materials and supplies 5.Rental/service 6.Administrative Activity 1 sub total Activity 2 1.Wages 2.Honorariums 3.Travel 4.Materials and supplies 5.Rental/service 6.Administrative Activity 2 sub total Evaluations etc. Evaluations etc. Sub total Total
Page 3-3 Budget breakdown related to agent Categories contents JFGE Grant (1,000 JPY) Funds on hand (1,000 JPY) Total (1,000 JPY) 1.Wages 2.Honorariums 3.Travel 4.Materials and supplies 5.Rental/service 6.Administrative Total of Representative-relat ed budget NOTE: This form should be filled out only by Non- Japanese organizations
Page 4 (Organization profile) (Phonetic Name of the organization transcriptions in kana) Name of the organization Location of the Address: principal office Tel: Date of establishment Structure of the Structure organization History Agent of the organization: Name: Title: If the organization has membership, provide the number and composition. Number of individual members: XX/annual dues of XX thousand yen Number of corporate members: XX/annual dues of XXX thousand yen Number of full-time directors: Number of part-time directors: Number of full-time staff: Number of part-time staff: Objectives *Please provide the name of the legal entity and the acquisition date exactly. (Including plans to acquire.) Past activities Fiscal Year 2015 (Budget) Fiscal Year 2014 Fiscal Year 2013 *If your organization has previously undertaken projects similar to the project for which JFGE Grant is requested, or projects that are supported, subsidized or commissioned by public bodies, be sure to list them. Financial information Website URL Contact person (Section/division and name) Total income(jpy) (JPY) (JPY) Total expenditures(jpy) (JPY) (JPY) Current term profit or loss(jpy) (JPY) (JPY) http://www. Contact address: Name: Tel: Fax: E-mail: *Provide the name of a person who is available to handle inquiries about the details of the project and who can be reached during normal business hours. In case of a Non-Japanese organization, give the contact address of the agent in Japan.
Page 5 List of staff and expert for the project for which the grant is requested Confirmation Sheet - List of Staff and Expert for the JFGE Grant Project in the Fiscal Name of the organization: Year 2016 Project type: Project area: *Be sure to describe list of members for the project below. List of members for the project Title Please describe managers, workers, and accountants who involve in the project (including the part-time job and volunteers, etc.). Years of Employment Name Remarks Experience status(paid/unpaid) In case of conducting surveys and researches, be sure to describe below. List of members for surveys researches conducting and In case of conducting surveys and researches, the document should provide a list of attendees engaged in the survey and their expertise. Name Affiliation Contents of Expertise *Please add the line properly if the description column is insufficient.
( 海 外 の 団 体 用 (for use by overseas organizations)) Power of Attorney 事 務 委 任 書 President Mitsuhiko FUKUI, Environmental Restoration and Conservation Agency of Japan 独 立 行 政 法 人 環 境 再 生 保 全 機 構 理 事 長 福 井 光 彦 殿 To apply for a grant for fiscal year 2016 from the Japan Fund for Global Environment, I hereby nominate to act as our agent in Japan who will deal with all procedural matters regarding this application and subsequent implementation of the proposed project:, if the grant is approved. 私 は 2016 年 度 地 球 環 境 基 金 助 成 金 要 望 書 の 提 出 に 関 し を 代 理 人 と 定 め 助 成 交 付 が 決 定 された 場 合 には 平 成 28 年 度 の 地 球 環 境 基 金 のすべての 助 成 手 続 に 関 し 一 切 の 事 務 処 理 権 限 を 委 任 します Both the applying parties and their agent in Japan have read and understood the above. 上 記 の 委 任 書 に 関 し 申 請 団 体 代 理 人 の 間 にて 了 承 されたことを 署 名 いたします 申 請 団 体 署 名 欄 (Organizations) 代 理 人 署 名 欄 (Agent in Japan) Name of Organization: 代 理 人 氏 名 : 代 理 団 体 名 : Address: 代 理 人 住 所 : Telephone & Fax number: 電 話 ファックス 番 号 : Date: 日 付 : Signature: 署 名 又 は 印 :
別 紙 : 代 理 人 の 資 格 に 関 する 書 類 / About qualification as an agent Applicant Organization: Agent (Organization): Agent (Individual): 1. 要 望 団 体 の 活 動 に 関 わった 実 績 について 述 べて 下 さい Please describe your experience related to the proposed project. 2. 要 望 活 動 の 代 理 人 を 引 き 受 けることにより 1 活 動 地 や 活 動 団 体 に 果 たし 得 る 役 割 2 日 本 の 市 民 社 会 や 地 球 環 境 基 金 に 果 たし 得 る 役 割 について 述 べて 下 さい Please describe your possible contribution for the I) project sites and applicant organization, and II) Japanese civil society, by undertaking the agent. 3. 添 付 資 料 Do you have any attachments? Answer below. (いずれかに 丸 を 付 けて 下 さい) 有 /Yes 点 /piece 無 /No
Reference material Outline of JFGE Outline of JFGE Endowment Government Citizens, Corporations and etc Subsidy for operation Donations Environmental Restoration and Conservation Agency Interest Japan Fund for Global Environment 142 141 million dollars Grants Program For Domestic For Oversea NGO support program Providing information Research and Studies Providing training program Advise Management Council