NetHope2017 Application
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Grant Application for NetHope 2017 Device ChallengeQuestions ColumnNotes Column
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Due to Sparky & Bear byFebruary 26, 2017(Will not be submitted)(Will not be submitted)
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Will be submitted to NetHope onFebruary 28, 2017
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Organization Name *
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Organization EIN or non-profit identification number *
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Organization Point of Contact Name *First name LAST NAME
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Job Title *
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Location (City/State, Country) *
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Email *
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Phone Number *
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Amount needed (in USD)? *
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Number of devices: Please provide the number of the various device types you plan to purchase & deploy.n/a
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How many phones will be purchased/deployed? *
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How many tablets will be purchased/deployed? *
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How many PC/laptops will be purchased/deployed? *
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How many other devices will be purchased/deployed? *
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Please provide name and information about suppliers you intend to work with to purchase the devices. *
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How many people will be targeted/impacted/served? *
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Geographic location of target population? *
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What are the primary development sectors impacted by this grant application? Check all that apply. *n/a
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Health
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Education
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Agriculture
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Environment
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Energy
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Financial inclusion
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Civic engagement
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Refugee response
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Other (please specify)
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Describe how the devices will be used to make a difference for program implementation and/or the target population. *Maximum Allowed: 500 words.
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Would your organization be interested in using volunteers to assist with its project?Yes or No
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Tell us how you will measure the social impact of the program that uses the purchased devices. *Maximum Allowed: 500 words.
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Describe what other resources or "co-investment" your organization will provide to ensure the successful integration of the purchased devices into your program. *Maximum Allowed: 500 words.
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Provide a short description of your organization and a summary of your capability to complete a successful deployment of these devices. *Maximum Allowed: 500 words.
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Co-marketing: *n/a
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We agree to share marketing opportunities with NetHope created from this grant.Yes or No
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We would be interested in presenting at upcoming ICT4D Conferences or the NetHope Global Summit.Yes or No
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We have additional ideas on co-marketing efforts outlined in attached document.Yes or No
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Budget: Please provide high level budget information as follows, totaling dollar amount requested above.In aggregate, minimum 60% of dollar amount requested must be spent on devices. Numeric values only - no characters allowed
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Cost of new phones in U.S. dollars *
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Cost of new tablets in U.S. dollars *
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Cost of new laptops/PCs in U.S. dollars *
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Cost of other new devices in U.S. dollars *
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Administrative, training and support costs for devices in U.S. dollars *
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Communications costs for devices in U.S. dollars *
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Other relevant information: Please attach a PDF Program Description (2-4 pages) with information to be considered in your application - template here (also, see instructions.) *
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Is the organization point of contact also the program manager of the project to be impacted by this grant? *Yes or No
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Is your organization a member of NetHope? *Yes or No
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* Required (i.e. everything)
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Source:http://solutionscenter.nethope.org/communities/nethope-2017-device-challenge#Application
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FAQ:http://solutionscenter.nethope.org/assets/collaterals/Program_Questions-Answers.pdf
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Program question form:https://nethope.wufoo.com/forms/x1ljsih215o4ram/
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Quarterly Reporting Form:http://nethope.wufoo.com/forms/x1gee4d80xz4hk5/
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