Request for Applications (RFA)

Counseling, Care and Support Center in Hanoi: Increasing access among PLHIV, OVC and families to a

comprehensive continuum of care

Implemented and Managed by FHI Viet Nam as part of the PEPFAR program in Viet Nam

Date of issue: 3-Feb-2009Due date for full applications: 13-Mar-2009

Applications shall be emailed to:haiha@fhi.org.vn

Questions by email ONLY:haiha@fhi.org.vn

Deadline for Questions: 13-Feb-2009

Issued by FHI Vietnam

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Table of Contents

I. PURPOSE............................................................................................................................................................3

II. RATIONALE.....................................................................................................................................................3

III. HIV COUNSELING, CARE AND SUPPORT CENTER: APPLICANT GUIDANCE...........................4

IV. MONITORING, EVALUATION, AND REPORTING ..............................................................................5

V. APPLICATION.................................................................................................................................................6

A. APPLICATION REQUIREMENTS..............................................................................................................6 B. SUBMISSION..........................................................................................................................................9 C. EVALUATION.........................................................................................................................................9

VI. APPENDICES................................................................................................................................................13

APPENDIX A: APPLICATION CHECKLIST.................................................................................................14 APPENDIX B: SUMMARY BUDGET TEMPLATE.........................................................................................15 APPENDIX C: INSTRUCTIONS FOR THE SUMMARY BUDGET TEMPLATE..................................................16 APPENDIX D: ORGANIZATIONAL BACKGROUND QUESTIONNAIRE FOR VIETNAMESE ORGANIZATIONS.18

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RFAHIV Counseling, Care and Support Center

I. Purpose

The purpose of this Request for Applications (RFA) is to solicit full applications for funding from non-governmental organizations (NGOs), including community-based organizations (CBOs), for an HIV Counseling, Care and Support Center in Hanoi. The RFA describes objectives of the project to be funded; explains the technical areas of focus, qualifications required of applicants and criteria for evaluating applications; and provides information on funding, the application procedure and format, and other relevant details.

This initiative is supported by FHI Vietnam with funding from the United States Agency for International Development (USAID) under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), is grounded in the comprehensive HIV prevention, care, treatment and support strategies of both PEPFAR and the Government of Viet Nam.

By 30-Sept-2009: Provide counseling, care and support to 150 PLHIV Train 50 providers in caring for PLHIV Provide care and support to 50 OVC Train 25 providers/caregivers in caring for OVC

In the subsequent 12 months (Oct 2009 to Sept 2010): Provide care and support to 500 PLHIV Train 150 providers in caring for PLHIV Provide care and support to 200 OVC Train 100 providers/caregivers in caring for OVC

The funding available for this grant in the first year (March 1-Sept 30, 2009) will not exceed US$50,000. From Oct 1, 2009 to Sept 30, 2010, the grant funding amount will not exceed US$100,000.

Issuance of this RFA does not constitute an award commitment on the part of FHI Vietnam, nor to provide for the costs incurred in the submission of an application. FHI Vietnam reserves the right to reject any and all applications, or to award a grant without further discussion or negotiations, if it is considered to be in the best interests of FHI Vietnam and PEPFAR.

II. Rationale

Access to HIV care, support and treatment services in Hanoi remains limited. The overall number of services, and the geographic spread of services has resulted in overflow of clients in certain out-patient clinics (OPC) and several districts without access to community-based care services.

For those who are enrolled in HIV out-patient clinics are doing better physically, limited services are available in Hanoi which assist PLHIV in mental health counseling, life and

family planning, job counseling, training, micro-credit and other forms of livelihood assistance.

Recent research among PLHIV in Viet Nam has found high rates of mental health problems which are often linked to anxiety regarding livelihoods.

In order to increase access to vital HIV care, support and treatment services, an HIV Counseling, Care and Support Center will be established in Hoang Mai District, located near the Hoang Mai District Hospital HIV OPC in order to promote linkages between the OPC, counseling and care, and community and home-based care services.

III. HIV Counseling, Care and Support Center: Applicant Guidance

The goal of the HIV Counseling and Suport Center in Hanoi is to improve quality of life of PLHIV, OVC and their families through increasing access to:

HIV testing and counseling services HIV care and treatment through basic care at the center, home-based care and

referrals to Hoang Mai OPC and other OPCs, health care service; building self-care skills including ART and other medicine adherence

Mental health services including counseling from trained professionals and referrals for treatment, and PLHIV support groups.

Structured livelihood support in the form of job counseling, training, micro-credit and other forms of support

Future planning counseling: assisting clients with disclosure, family planning, preparing wills and documents for children

Care for OVC: parents/caregiver capacity building in parenting skills, child and family counseling, early childhood development activities, life-skills education for older children, linkages to social welfare services

HIV prevention support: providing counseling for safer sex and drug use, linkages to needle and syringes exchange, methadone, STI referrals and PMTCT

Applicants must describe in details how they intend to provide the above services through the Center. Please consult the following MoH and PEPFAR guidance for further information on the above services and approaches:

Palliative Care Guidance: http://www.state.gov/documents/organization/64416.pdf. OVC Guidance: http://www.pepfar.gov/documents/organization/83298.pdf). Palliative care for people with cancer and HIV, MOH Viet Nam

If unable to identify these references, please contact Ms. Nguyen Hai Ha (haiha@fhi.org.vn)at the FHI office for hard copies: Strategies for increased access to care:

1. City-wide marketing and promotion of the Center: This will be done through radio, print media and TV.

2. Extended hours: Offering care and counseling in the evening for those that work or are otherwise unable to access care services from 9-5.

3. Hotline: A 24-hour hotline will be managed by the center to ensure that those who are unable to come to the center are able to access the services they need when they need them.

4. Home-based care: In collaboration with CHBC team at Hoang Mai OPC, ensuring clients in Hoang Mai and the surrounding area are able to access home-based care through the Hoang Mai OPC or other services in Hanoi.

5. Dynamic referral system: Ensuring improved access to services not offered at the Center through formal referral relationships, up-to-date service directory, accompanied referrals where needed.

A clear and feasible description of how increased access and utilization of the Center needs to be included in the applications. Applicants are encouraged to include additional creative strategies to increase uptake of Center services.

Human resource considerations: In order to provide the above comprehensive set of services, the HIV Counseling and Care Center will need to be staffed with trained nurses, physicians, counseling and testing counselors, mental health counselors, PLHIV peer counselors, livelihood specialists, and child/family social workers.

The applicant will need to demonstrate that they are capable of recruiting, mentoring and training the above staff.

Infrastructure considerations: In order for the HIV Counseling, Care and Support Center to be well utilized it needs to be comfortable, clean and accessible.

The applicant will need to describe how they would select, design and manage the Center to it is attractive, confidential and retains clients.

Continuum of care: The Center will be formally linked to the Hoang Mai HIV out-patient clinic. The clinic provides the following services for adults and children:

Palliative care, prevention and treatment of OIs TB/HIV screening and referral ART and adherence counseling PLHIV support group Community and home-based care Through CHBC, supportive services to OVC including health care, psychosocial

support, nutrition and food security support, education assistance, and protection. Referrals to other health and social welfare services

The Center will take on a greater role of providing center-based emotional, social and spiritual care to PLHIV and OVC, complementing and enhancing the services offered by the Hoang Mai OPC.

IV. Monitoring, Evaluation, and Reporting All applications must include specific, detailed plans to monitor and document program performance (progress on, quality of, and results/outcomes of activities). FHI Viet Nam will assess progress against required indicators (below) quarterly. FHI Viet Nam will conduct routine QA/QI to track progress of the project and provide supportive supervision.

Applications should state clearly how proposed activities relate to the goal of the RFA, and how and when data will be tracked, collected, verified and reported. Applicants should describe in detail the systems they have or will establish to gather data on an ongoing basis to

guide decision-making and improve program effectiveness. To the extent feasible, systems for data collection and analysis should be designed with an emphasis on building local capacity. Applicants should list the indicators of program progress and effectiveness they will track in their application.

Required PEPFAR/FHI indicators for this RFA include (8):

Care and support for adult PLHIV: Number of individuals provided with HIV care and support, including two sub-

indicators:o Number of PLHIV provided with HIV care and support, disaggregated by

sexo Number of family members (of PLHIV) provided with HIV-related care

and support, disaggregated by sex Number of individuals trained to provide HIV care and support for PLHIV

Care and support for OVC: Number of OVC served, disaggregated by sex and:

o Number of OVC receiving “primary direct support” (i.e., support in 3 or more of the PEPFAR OVC areas1)

o Number of OVC receiving “supplemental direct support” (i.e., support in 1-2 of the PEPFAR OVC areas)

Number of providers/caregivers trained in caring for OVC

For further details on the above PEPFAR indicators, please refer to: http://www.pepfar.gov/documents/organization/81097.pdf.

The applicant will also need to specify additional indicators which will be tracked in order to measure out-puts and quality. Finally, the applicant should describe how they will use this data to improve quality of the Center services.

V. Application

The application is intended for Vietnamese NGOs only with preference to those who have experience with managing grants larger than US$20,000.

A. Application Requirements

All applications received by the deadline will be reviewed for responsiveness to the program requirements and compliance with the preparation guidelines provided below. Applications that are non-responsive will not be considered for further review and applicants submitting such applications will be notified within 15 days. Application requirements are as follows:

Format1. In English or Vietnamese2. For the proposal narrative, typed in a Microsoft Word compatible program, single-

spaced with Times New Roman 12 pt font and one inch margins all around

1 The PEPFAR OVC care areas include: health care, nutrition, shelter and care, education, child protection and psychosocial support.

3. Labeled with page numbers and the name of the submitting organization on every page.

Content includes:

1. Cover Page with program title; organization name and contact information including address, telephone, fax, and email address

2. Table of Contents

3. Executive summary (maximum 1/2 page)

4. Technical application (maximum 15 pages). In the technical application, include:

a) Technical approach/intended results (maximum 10 pages) detailing the following: Project goals, objectives Project location and geographical coverage, including rationale for

selection Targeted beneficiaries (i.e., PLHIV, OVC) and their needs Anticipated numbers of beneficiaries to be reached and served, per group Key activities/interventions and processes (where appropriate, include

anticipated outputs and outcomes)o service provision structure (who are service providers, how are they

organized, supervised and supported, etc.)o service package (which services will be provided to each target

population, who will provide these services)o capacity building activities for project staff, service providers, etc.o how these activities meet the needs of beneficiaries and contribute to

project objectives Project partnerships

o Direct implementing partner(s), if anyo Linkages to PEPFAR-supported clinic(s)—preferably specifying

linkages to specific personnel within the clinic(s)—and the purposes of the linkages

o Linkages to other locally available social support services Consideration of basic principles in working with PLHIV and OVC, e.g.,

o Best interests of PLHIV and OVCo Confidentiality and respect for PLHIV and OVC rightso Reduction (or avoidance of increase) in HIV-related stigma and

discriminationo Participation of PLHIV, OVC and families as part of the solution

A monitoring, evaluation and reporting plan (please also refer to Section IV, Monitoring, Evaluation and Reporting, above)

b) Project Management (maximum 5 pages) Past performance and experience implementing programming with

PLHIV, OVC and/or other relevant programming Proposed implementing partners and division of responsibility

Implementation plan (can be in the form of a Gantt chart) illustrating activities for the implementation period (ensuring that activities that appear in Gantt chart also appear in the technical sections above)

Staffing and management plan/chart Sustainability plan

5. Cost application for 18 months of programming. In the cost application, include:

a) A Summary budget (template attached in Appendix B) including the following line items: Personnel Fringe benefits Travel Equipment & Supplies Monitoring and Evaluation Proposed sub-grants and sub-contracts Other direct charges Indirect charges (allowed for international NGOs with USAID Negotiated

Indirect Cost Rates (NICRA) only)

b) A detailed budget itemizing items included under the summary budget lines above. Ensure that activity items that appear in the detailed budget are also specifically referenced in the technical application.

c) A budget narrative explaining how cost items are constructed and calculated, for items that have not been fully explained by the detailed budget.

6. Attachments should include:

a) An organizational capacity statement that provides information demonstrating the applicant’s capacity to implement the proposed program (maximum 2 pages). The statement should present: A brief overview of the applicant’s mission and goals and how they relate

to the proposed program Relevant experience in relation to the proposed program, geographic area,

and target population Comparative advantage in carrying out this work, such as prior successes

in similar endeavors Key personnel (maximum 2), who are necessary for the effective

implementation of project. Include the name and a short description of each individual’s experience and capacity relevant to the project.

b) CVs for each of the key personnel

c) Reference information for at least 3 donors with whom applicant has worked in the past 3 years in the implementation of a similar program. If you do not have 3 donors to reference, please provide information for as many as possible. All references must include the donor organization’s name, contact person’s name, mailing address, telephone and fax number, email address,

grant agreement number if available, funding amount, and a brief description of the work, including dates performed.

d) Completed organizational background questionnaire for prime applicant and sub-partners (please refer to Appendix E and F for the appropriate questionnaire for Vietnamese and international organizations, respectively)

B. Submission

Applications must be received by FHI Viet Nam no later than close of business (5:00 pm) on 13-Feb-2009 to be considered for funding. While it is not anticipated that late applications will be reviewed, FHI Vietnam reserves the right to consider any application for review at its discretion.

Applications shall be emailed to haiha@fhi.org.vn

Applicants who cannot email the application may mail the application by post to:

Nguyen Hai HaFHI Viet Nam3rd Floor1 Ba Trieu, Ha Noi, Viet Nam.

C. Evaluation

Evaluation process

1. Review of application based on compliance with all eligibility requirements specified within this RFA (eg could be disqualified if it does not include all items required, or if the proposed project exceeds the budget limitations).

2. Scoring of applications against the below criteria. A team of FHI and non-FHI staff will review applications and provide scores. Applicants with the highest average scores will be considered for funding.

Evaluation Criteria

Applications will be evaluated according to the criteria listed below. Points are associated with each category so applicants can see which sections are weighted more heavily than others.

Program strategy and approach 50 pointsExcellence of designLinkagesM&E planPrinciples of working with PLHIV, OVC

Capacity to deliver 35 pointsProject ManagementKey personnel

General Organizational experienceReferencesSpecific experience implementing similar programs

Budget/cost realism 15 points

Program Strategy and Approach 50 points

Excellence and feasibility of design. Reviewers will evaluate the overall quality and feasibility of the program design. A strong technical design will include: A discussion of key issues and best practices related to care and support for PLHIV and

OVC, and how these will be applied in the context of this program Program objectives relevant to the objectives of this RFA and to the issues discussed Clear presentation of how proposed activities will contribute substantially to the

objectives Compelling description of how applicant will improve access to and retention in Center

services Feasible and creative approach the design and infrastructure of the Center Proposed activities relevant to and feasible in the Vietnamese context Evidence to illustrate that proposed activities will produce results, detailing how and

where targets will be achieve

Demonstrated continuum of care, functional linkages to existing PEPFAR-supported HIV clinics and other social support services. Consideration will be given to how well the proposed program will coordinate with relevant stakeholders and partners, in particular: Functional linkages to and synergies with existing PEPFAR-supported HIV clinic(s) Functional linkages to locally available social support services and other community-

based care and support services for PLHIV and OVC Proposed partnerships to mobilize and utilize other resources available to PLHIV and

OVC

Monitoring and Evaluation Plan. Please also refer to Section IV, Monitoring, Evaluation and Reporting. The following will be considered: Relevant and feasible indicators, including required PEPFAR indicators and other

identified indicators Feasible and appropriate tools and methods to collect the data necessary to report on the

chosen indicators and to evaluate the program Milestones and expected accomplishments Relevant disaggregation of data by sub-groups of the target population Plans to use the data to identify and address programmatic weaknesses, and to promote

programmatic strengths

Adherence to basic principles of working with PLHIV and OVC. The scoring of applications will take into consideration whether the program design adheres to the following principles: Best interests of PLHIV and OVC Respect for the rights of each PLHIV and OVC, including the right to confidentiality of

his/her HIV status or his/her parents’ HIV status (in case of OVC), and the right to decline services

Reduction (or avoidance of increase) in HIV-related stigma and discrimination

Active and meaningful participation of PLHIV, OVC in the program

Capacity to Deliver 35 points

Management approach. Reviewers will consider the overall plan for managing the project, including staffing and expertise, systems for collaborating, implementation plans, and clarity of linkages between the proposed approach and intended outcomes. Factors to be considered include:

Technical skills and experience of proposed key personnel related to HIV/AIDS related programming, including care, support, treatment or prevention programming, or care and support programming for other vulnerable groups

Experience of key personnel working in Viet Nam or similar environments Experience working with local authorities and organizations in proposed intervention area Complementarity of the staffing plan and proposed personnel, appropriateness of

proposed staff for activities Sufficient level of effort designated to the program to carry out the scope of work Presence of or potential to develop linkages with PEPFAR-supported HIV clinic(s) and

other local organizations/programs in order to mobilize other available social support services to benefit PLHIV/OVC

Demonstration of how the proposed management structure and approach will ensure program effectiveness

Clear and comprehensive implementation plan Realism of implementation plan, inputs, and outputs; feasibility within the proposed

budget and timeframe Clarity of overall organizational structure and relationships, including planned

interactions with other PEPFAR partners and other programs supported by other donors Potential for rapid mobilization post-award

Key Personnel. The key personnel proposed for the project will be evaluated on the basis of: Experience working on similar projects Appropriate technical skills Demonstrated networks with key stakeholders in Viet Nam–or proven ability to develop

such networks

General Organizational Experience. The applicant’s past performance will be evaluated to assess the overall quality of its performance in the past, with a focus on the following areas:

Quality of service (including consistency in meeting goals and targets, effectiveness in solving problems);

Cost control (including forecasting costs as well as accuracy in financial reporting) Timeliness of performance (including adherence to schedules and ability to make prompt

decisions and ensure efficient operation) Effectiveness of key personnel Experience coordinating diverse activities that produced documented results Results in program monitoring and evaluation. Demonstrated capacity to develop an effective system for managing sub-grants/sub-

contracts, or any other method proposed for engaging other organizations in the conduct of the program

References will be checked to assess applicant’s past performance based on the factors listed above.

Specific experience implementing similar programs. The review committee will consider the applicant’s (and partners’) demonstrated experience in delivering similar services (community-based care and support for PLHIV and OVC ) and other closely related interventions. Evaluation will be based on documented results and the same factors listed above for general experience.

Budget/Cost Realism 15 points

The application will be evaluated based on the realism of proposed costs, including program vs. administrative costs. The budget should be in keeping with applicable Cost Principles and USAID regulations and policy (see Section D below for web references). The total budget will be evaluated for reasonableness and realism as it relates to the proposed program description. The overall budgetary competitiveness of the application may be determined based on a ratio of program vs. administrative costs and on cost per beneficiary served.

Substantial Involvement

FHI Viet Nam will provide technical support and build partner capacity, as needed, to plan, implement, monitor and evaluate effective programming. FHI will be engaged in the following: Approval of key personnel

Approval of implementation plans and all modifications describing the specific activities to be carried out under the Agreement

Approval of annual targets, and any changes therein Approval of annual budgets Approval of a USAID branding strategy and marking plan (guidance to be

provided post-award) Approval of monitoring and evaluation plans Monitoring of project objectives through regular virtual/telephone

communication, site visits, and review of reports Provision of technical guidance on the project’s service package, service

organization and capacity building plans Provision of technical support/capacity building services via on-site support,

trainings, and workshops, as appropriate Review and approval of conference abstracts, reports or other public materials.

VI. Appendices

A. Application checklistB. Summary budget templateC. Instructions on the summary budget templateD. Organizational Background Questionnaire for Vietnamese Organizations

Appendix A: Application Checklist

Complete Full Application which includes the following sections:

1. Cover Page with program title; organization name and contact information including address, telephone, fax, and email address

2. Table of Contents

3. Executive summary (maximum 1 page)

4. Technical Proposal (15 pages maximum)

a. Technical approach (10 pages maximum) (check to make sure all required contents are included)

b. Project Management (5 pages max) (check to make sure all required contents are included)

5. Cost Proposal a. Summary Budget b. Detailed Budget c. Budget Narrative

6. Attachmentsa. Organizational Capacity statement, including summary descriptions of key staff (2

pages maximum)

b. Reference information for at least three donors. If you do not have three donors to reference, please provide information for as many donors as possible.

c. CVs of key personnel (no more than two CVs)

d. Completed Organizational Background Questionnaire for prime applicants and partners (see Appendices D)

Appendix B: Summary Budget Template

Organization: _________________________Project title: __________________________

Exchange rate: US$1=   VND

Line Item Categories 

Amounts

1 Personnel (list each separately with LOE)  2 Fringe Benefits  3 Consultants and Professional Fees4 Procurement5 Travel (separate lines for international and domestic)  6 Office Expenses  7 Other Direct Costs  8 Sub-recipients (list each separately)  Total Direct Charges (total 1 to 8)     Indirect Charges (see instructions in appendix D)       TOTAL  

See instructions for line items in Appendix B.

Make sure all amounts are correct and in US dollars. Please include the current USD to VND exchange rate.

Indirect Charges - only include as a percentage of direct costs if organization has an approved USAID Negotiated Indirect Cost Rate Agreement (NICRA).

Appendix C: Instructions for the Summary Budget template

Please be sure to review and confirm that all amounts and formulae are correct. Budget are calculated in VND and converted into US Dollars at the prevailing exchange rate. Please indicate the exchange rate used in the budget.

A DETAILED BUDGET and BUDGET NARRATIVE describing all costs are required.

Budget Instructions:

PersonnelPlease list each person separately, including their title/position. The personnel line item must clearly indicate that person’s salary and their anticipated Level of Effort (LOE), which is the time a staff member contributes to the project against his/her total working hours (for example the project manager spends 75% of her working time on the project, so she receives 75% her total salary from the project). LOE can be represented in terms of the number of work days or the percentage of overall work time that will be dedicated and charged to the project budget.

Fringe BenefitsFringe benefits are additional personnel costs that are either required by local law or are provided according to common practice and your organization’s written policies applicable to all staff. Examples of this are mandatory contributions to the national health and social insurance fund; severance pay accruals; private health and accident insurance. Fringe benefits are also calculated based on LOE. For example, if a project manager will spend 75% of her time on the project, 75% of her fringe benefits costs can also be charged to the project.

Consultant and Professional FeesPlease list each of the consultants or professionals to be required for the grant by scope of work. Indicate number of days and proposed rates for each of the consultants and professsionals.

ProcurementEquipment and furniture with unit price of US$1,000 and more will be included in this category.

Do not plan to use project funds to buy medicines and condoms, because PEPFAR procures medicines and condoms centrally and supplies to implementing organizations. Do not plan to use project funds to buy needles and syringes for drug users, as this is not allowed by PEPFAR.

TravelPlease include separate lines for international and domestic travel. Please include all costs for travel to be charged to the grant as well as any lodging/per diem to be provided to staff while traveling. This should not include local transportation costs in the project area; these can be listed under “other direct costs,” below.

Office ExpensesExpenses such as rent, utility, communication, supplies, bank fee for the head office to manage the project will be included in this category. The office expenses charged to the project should be calculated based on a reasonable allocation methodology, such as the proportion of the proposed budget in relation to the organization’s total budget for the project period, or the LOE of the project in relation to the whole staffing level of the organization.

Other Direct Costs

This category include costs related to specific project activities (which may be grouped by activities), which do not fall into the categories above (personnel, fringe benefits, travel, equipment and supplies, monitoring and evaluations, subgrants and sub-contracts).

Sub-recipientsPlease list each sub-recipient separately and the detailed budget for each of the sub-recipients.

Indirect Costs Only US NGOs with a Negotiated Indirect Cost Rate (NICRA) approved by the US Government may charge for indirect costs as a proportion of the direct cost budget. (Other NGOs may charge these expenditures directly. See above “Other Direct Charges” for further details.)

Appendix D: Organizational Background Questionnaire for Vietnamese Organizations

Directions: Complete form and submit with application

Organization Name: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      

Contact Name: FORMTEXT      Title: FORMTEXT      Address: FORMTEXT      City/Province: FORMTEXT      Country: FORMTEXT      Telephone: FORMTEXT      Fax Number: FORMTEXT      E-mail Address: FORMTEXT      Website (if any): FORMTEXT      

Please indicate type of Organization (please select one only):Local NGO FORMCHECKBOX Local Faith-Based Organization (FBO) FORMCHECKBOX Community-based Organization (CBO) FORMCHECKBOX Local Private Company FORMCHECKBOX Other FORMCHECKBOX Please explain _____________________________

Amount of Funding Requested (in US$): FORMDROPDOWN

Year organization was established: FORMTEXT      

Years of experience in HIV/AIDS programming: FORMDROPDOWN

Years of experience in HIV/AIDS care and support programming: FORMDROPDOWN

What is your organization’s approximate annual operating budget (in US$)? FORMDROPDOWN

What is the number of staff members of your organization? FORMDROPDOWN

Does your organization have a board of directors? Yes FORMCHECKBOX No FORMCHECKBOX

How many volunteers does your organization have? FORMTEXT       FORMTEXT      

Is your organization currently receiving direct USAID funds? Yes FORMCHECKBOX No FORMCHECKBOX

If yes, please indicate funding in US$: FORMDROPDOWN

Has your organization received direct USAID funds in the past five years? Yes FORMCHECKBOX No FORMCHECKBOX If yes, please indicate funding in US$: FORMDROPDOWN

Is your organization currently receiving USAID funds through another NGO (e.g., INGOs such as Pact, FHI, CARE, CRS, Pathfinder, etc.)Yes FORMCHECKBOX No FORMCHECKBOX If yes, please: Indicate funding in US$: FORMDROPDOWN

Specify source(s) of funds: FORMDROPDOWN

Has your organization received USAID funds through another NGO in the past five years (e.g., INGOs such as Pact, FHI, CARE, CRS, Pathfinder, etc.)Yes FORMCHECKBOX No FORMCHECKBOX If yes, please: Indicate funding in US$: FORMDROPDOWN

Specify source(s) of funds: FORMDROPDOWN

If you have other sources of funding, please indicate (list up to three, including funding amounts): FORMDROPDOWN

Is your organization currently receiving funds through the United Nations (UN)?Yes FORMCHECKBOX No FORMCHECKBOX If yes, please indicate funding in US$: FORMDROPDOWN

Has your organization received funds through the United Nations (UN) in the past five years?Yes FORMCHECKBOX No FORMCHECKBOX If yes, please indicate funding in US$: FORMDROPDOWN