2016 whitley award application form final 2

2016 Whitley Award Application Form This application form can only be completed with the help of the Guidance for Applicants Document. Guidance is available on all questions.

APPLICATION DETAILS____________________________________________________________

1. Name of applicant 2. Application title 3. Country where project is based 4. Organisation information Name of organisation: Status (NGO, charity, non-profit, society, university etc): Date established: Charity number: Age of project for which applying:

5. Contact Details Address: Telephone (with code): Skype: Email/s (indicate preferred): Website/s: Known periods when project leader will be unavailable (winning applicants must be available to attend the Whitley Awards Ceremony in London, UK, in late April 2016):

6. Location of project site a) Location(s) + brief description (please include maps): b) Latitude: Longitude:

7. How did you hear about the Whitley Awards?

Source Direct contact from WFN Previous Whitley Award winner Colleague WFN Website Non-WFN website Other

Details

8. Have you previously received funds from: Whitley Fund for Nature London, U.K. t: +44 (0)20 7221 9752 e: info@whitleyaward.org w: www.whitleyaward.org Page 1

Whitley Fund for Nature London, U.K. t: +44 (0)20 7221 9752 e: info@whitleyaward.org w: www.whitleyaward.org Page 2

Yes

No

Year Awarded

Grant amount (GBP)

The Whitley Fund for Nature The Rufford Foundation or Rufford Small Grant (RSG) The Conservation Leadership Programme (CLP) Darwin Initiative Fauna and Flora International (FFI) WWF b) If this is not your first application for a Whitley Award, please give details of previous applications:

PERSONAL PROFILE_________________________________________________

9. Personal Summary a)

Nationality:

b)

M/F:

c)

Date of Birth AND Age:

d)

Current job title/ position:

e)

Education summary:

f)

Languages:

g)

Previous related work and achievements (use bullet points)

h)

Key publications and notable Awards (use bullet points)

i)

Experience as a team leader (use bullet points)

PROJECT___________________________________________________________

10. Executive summary (please summarise your proposed project in 200 words) 11. Your work a)

b)

Issue(s) your project is addressing:

Project objectives (use bullet points e.g. objective 1,2,3 etc. Objectives should be SMART: Specific, Measurable, Achievable, Realistic and Timely):

c)

Project beneficiaries:

d)

Socio-political context:

e)

Evidence of success to date:

12. Methods a) Theory of Change (ToC) (what is your ToC) b) Methodology (please describe the activities you will undertake under each of your objectives)

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13. Logical Framework Overall Goal: Objectives

Activities

Output Indicators

(what is required to achieve the goal, should mirror 11 b)

(What you will do to achieve the objectives)

(Indicators that will demonstrate clearly the activity is effective)

Objective 1.

1.1

1.1.1 1.1.2 1.1.3

Risks & Assumptions

(and how you will overcome them)

Objective 2.

Risks & Assumptions (and how you will overcome them)

14. Conservation outlook (no more than 300 words) 15. Describe how will you measure your impact/success in each of the below areas: a) Biological b) Social (e.g. human wellbeing) c) Political (we recognise that not all projects will have an impact at the political level)

16. Timeline (Please fill in the boxes to show when each activity will take place) Month Activity

No, of months

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

Objective 1

Objective 2

Objective 3

Etc

17. Project need (why is the project urgent, and what would happen without it?)

Whitley Fund for Nature London, U.K. t: +44 (0)20 7221 9752 e: info@whitleyaward.org w: www.whitleyaward.org Page 4

May

Jun

18. What steps are you taking to ensure project sustainability? (e.g. financial and succession planning)

19. Team members List all members involved in this project (including you).

Name

Age

M/F

Nationality

Role and employer

Qualifications/ Experience

Where based and Full/ Part time? (giving hours per week to be spent on proposed project)

20. Collaborating organisations List your links with other organisations/ NGOs/ universities/

Ministries that will be critical to your on-going success, and how they are contributing to the project (specify funding, knowledge sharing, resource sharing, etc.).

Organisation

Active/propose d relationship

When relationship established

Formal (MOU signed) /informal

Contribution to project

MEDIA_____________________________________________________________

21. Dissemination of results How will you disseminate the results of this work and

maximise replication for conservation benefit (share results, publications, use of media, conferences, education)?

22. Photographs As part of your application please submit 10 photos to illustrate your work

and which WFN could use for publication purposes if your application is successful. These should be emailed separately across 2-3 emails as jpegs.

Photo number, your surname, photo name (to correspond with file name of the photograph you attach). If a photo needs crediting, please provide it.

Example 1_Smith_bushmeat_ credit Danni Sennett 1 2 3 4 5 6 7 8

Photo caption (include subject and where taken)

Example Bushmeat confiscated from illegal hunters from Galmond National Park

Whitley Fund for Nature London, U.K. t: +44 (0)20 7221 9752 e: info@whitleyaward.org w: www.whitleyaward.org Page 5

9 10

23. Footage and photos

Are you able to provide additional high quality footage, photographs and other media to WFN for the production of short films and publicity materials about you and your work?

FINANCE________________________________________________________________ _

24. Summary Financial questions ALL Projects run by NGO/organisation

Local Currency

GBP £ Conversion

Total income and expenditure last Financial Year (FY):

Income: Expenditure:

Income: Expenditure:

Total of funding proposals currently pending (across all programmes and for other purposes, including core costs):

This Specific Project

Local Currency GBP £ Conversion

Income and expenditure last FY (or for previous related project if new):

Income: Expenditure:

Income: Expenditure:

Total funding required for next year (all donors): Total funding already secured for next year (all donors): Total of funding proposals pending: Total funding still to be sourced (funding gap):

Rate of exchange used & date: __________________________________ 25. Financial Information a) Financial Governance Please submit the following items separately along with your application unless indicated otherwise. Please do not embed scans of documents into this application form.

i) NGO/organisation certificate)

Founding

documents

(e.g.

constitution;

registration

ii) Latest Audited Financial Statements/Accounts (or alternative, if not available) iii) Explanation of Financial Controls of your NGO/organisation (provide a written summary below)

b) Project Budgeting All budgets MUST be in £GBP. Include rate of exchange used for conversions and date.

Whitley Fund for Nature London, U.K. t: +44 (0)20 7221 9752 e: info@whitleyaward.org w: www.whitleyaward.org Page 6

i) Historical project budget (can be inserted below or submitted as a separate attachment): ii) Forecast project budget (must be inserted into document and NOT as a separate attachment) It is important that your budget can be clearly linked to your project objectives: iii) Explanation of budget: iv) How funding gap will be filled:

26. Your Fundraising a) For the Project

In the table below, please state:

-

Funding already secured for this specific project for next year (all donors) other funding applications for the project made within past 12 months which were declined Current or planned funding proposals with outcomes pending for this specific project

-

Name of funding body

Funding amount applied for (GBP ÂŁ)

Date of proposal

Date of decision

Outcome (granted, pending or declined)

Grant start & end dates (and year)

b) For the NGO / Organisation In the table below, please state

-

other current funding secured for your NGO/Org for next year not related to this project. other funding applications for your NGO/Org not related to this project made within past 12 months which were declined total of funding proposals for your NGO/Org not related to this specific project with outcomes pending

Name of Funding body

Funding amount applied for (GBP ÂŁ)

Date of proposal

Date of decision

Outcome (granted, pending or declined)

Grant start & end dates (and year)

27. Delivery of funds LEGAL __________________________________________________________________ _

28. Declaration from the Applicant I confirm I have understood WFN aims to share, with my help, elements of the report from this Whitley Award grant with other members of the Whitley Award Alumni via the WFN website to facilitate the sharing of best practice in conservation.

Yes Whitley Fund for Nature London, U.K. t: +44 (0)20 7221 9752 e: info@whitleyaward.org w: www.whitleyaward.org Page 7

‘The information submitted in this application is true, to the best of my knowledge, information and belief.

Should any significant developments arise after this application is made, I shall notify the WFN office immediately. I consent to the information contained in this application being held on computer and circulated to members of the Whitley Judging Panel, other interested parties and the media, under the terms of the Data Protection Act, 1984. I have requested the three referees named above to send their reference statements directly to the WFN office by the deadline and I understand that the opinions of referees and reviewers remain confidential to WFN and the Whitley Judging Panel and will not be disclosed to me, the applicant. I furthermore understand and give permission for the photographs I have sent in support of my application, and any further photos, video footage, music and any other visual and audio materials I later forward as part of my application, may be used to promote my work in the media, and other locations WFN deem appropriate, including in WFN publication materials and at the Whitley Awards Ceremony, and, should my application be successful, to promote the WFN as a donor to my work. I understand it is my responsibility to secure right of use over such materials before forwarding them to WFN and that I consent to their use by WFN as stated.

I understand that the Whitley Awards is an international competition and that the Judging Panel’s decision is final. I furthermore understand the Whitley Awards aim to fund and champion the work of dynamic conservation leaders who are effective communicators dedicated to spreading positive conservation learning and understanding globally. I understand what the Whitley Award is, a monetary grant to support the work outlined in this proposal, and a publicity prize applied for by conservationists who seek publicity for their work and who share the collaborative ethos outlined above.

Should I succeed in being shortlisted as a finalist, I will be invited to the U.K. for interview by the Judging Panel and to take part in a week of events in London in late April. I understand that if I am selected as a finalist but am unable to come to interview this constitutes withdrawal from the competition. I understand that if I am selected as a finalist, I will be asked to provide video footage of my project work and further photographs to supplement my application, and that I will do everything I can to provide these materials quickly. I understand that if I win the Award the WFN team will assist me in publicising the work of my project and that, whilst publicity success is not guaranteed, I will do all that I can to assist WFN and will proactively take forward appropriate media opportunities. I confirm that to the best of my understanding and knowledge, winning the Whitley Award and attracting any associated publicity will benefit and do no harm to the conservation project or associated communities described in this proposal.’

Signature & Date: _______________________________________________

29. Referee Statements Name 1.

2.

3.

Position

Address

Telephone

Email (required)

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