VOSH/International - VOSH OGS application

VOSH APPLICATION FOR OPTOMETRY GIVING SIGHT FUNDING

IN SPANISH AND ENGLISH

VOSH/OGS Grant Application

Applicant (Name of organization)

Contact Details (Name, position, address, phone number, fax number, e-mail address, web site):

Charity/Trust number, if applicable: (Please attach a copy of documentation regarding the organization's non profit status.)

Please attach most recent Annual Report or attach details of the aims of organization, mission statement, current activities, type of organization, date established, income and expenditures for previous year.

Name/Location of Project:

Grant amount being requested (in U.S. dollars):

Aim of Project:

Specific services to be provided:

Expected outcomes (the impact sought or expected from the Project):

Strategies (brief description of approaches and activities, other NGOs/organizations involved, collaborations):

Budget (staff, equipment, other direct program and overhead costs):

Project income (other sources/possible sources of income, contributions/expected subsidies to the project):

Budget (staff, equipment, other direct program and overhead costs):

Project income (other sources/possible sources of income, contributions/expected subsidies to the project):

Performance indicators...how will you measure success of the Project?

Project timelines (main activities with duration):

Monitoring, reporting and evaluation (provide a timetable for outcomes reporting and assessment criteria):

1) Include a statement on how the Project will:
a. Have a significant and sustainable effect on eliminating blindness and impaired vision due to uncorrected or under corrected refractive error, and/or,

b. Develop programs and models that will improve the quality of life for those with (permanent) low vision.

2. Include a statement on how:
The Project should comply with VISION 2020 aims with regard to eliminating blindness and impaired vision due to uncorrected refractive error and/or aiding those with permanent low vision.

Please indicate how the Project addresses the following:
a) Adherence to Optometry Giving Sight goals and priorities i) Provision of direct services ii) Relevance to eye care needs iii) Impact and cost effectiveness iv) Sustainability and capacity building through: • human resource development • development of systems for eye care service delivery or infrastructure and technology development • empowerment of the people in the community involved.

b) Demonstrated understanding of local eye care needs and infrastructure

c) Demonstrated ability to manage grants and budgets

d) Demonstrated organizational capacity

e) Focuses on communities and areas with the greatest and most immediate needs

f) Fits into the government’s national blindness prevention plan, e.g. VISION 2020 plan (please attach the country’s national plan if available)

g) Appropriate registration of NGO in project country and membership in VISION 2020

h) Demonstrates collaboration and participation with other in-country NGOs

i) Demonstrates collaboration and participation with professionals in the country or area concerned

j) Has been appropriately and reasonably costed

k) Builds on Optometry Giving Sight Priority Projects and/or current programs funded by Optometry Giving Sight

3) Demonstrate endorsement by in-country partner organizations and if possible, the appropriate government agency

4) Provide two non-partner references for Project and/or organization

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