To be APPLICATION FORM TO UNITED STATES AGENCY FOR INTERNATIONAL
DEVELOPMENT (USAID)

**SMALL AWARDS PROGRAM**

#### FOR

**LEBANESE NON-PROFIT ORGANIZATIONS -- PRIVATE VOLUNTARY ORGANIZATIONS
(PVOs)**

**AND**

**LEBANESE FAITH-BASED ORGANIZATIONS (FBOs)**

+--------------------+-------------------------------------------------+
| **APPLICANT        |                                                 |
| DETAILS**          |                                                 |
+--------------------+-------------------------------------------------+
| **Type of          |                                                 |
| Organization       |                                                 |
| (Check one of the  |                                                 |
| options below)**   |                                                 |
+--------------------+-------------------------------------------------+
| a\) Applicant is   |                                                 |
| Lebanese           |                                                 |
| non-profit         |                                                 |
| organization --    |                                                 |
| Private Voluntary  |                                                 |
| Organization (PVO) |                                                 |
+--------------------+-------------------------------------------------+
| b\) Applicant is   |                                                 |
| Lebanese           |                                                 |
| Faith-Based        |                                                 |
| Organization (FBO) |                                                 |
+--------------------+-------------------------------------------------+
| **Name of          |                                                 |
| Organization**     |                                                 |
+--------------------+-------------------------------------------------+
| **Name of          |                                                 |
| Organization in    |                                                 |
| Arabic**           |                                                 |
+--------------------+-------------------------------------------------+
| **Chief of         |                                                 |
| Organization       |                                                 |
| Name**             |                                                 |
+--------------------+-------------------------------------------------+
| **Chief of         |                                                 |
| Organization       |                                                 |
| Title**            |                                                 |
+--------------------+-------------------------------------------------+
| **Contact Person   |                                                 |
| Name**             |                                                 |
+--------------------+-------------------------------------------------+
| **Contact Person   |                                                 |
| Title**            |                                                 |
+--------------------+-------------------------------------------------+
| **Contact Person   |                                                 |
| Cellular Phone     |                                                 |
| Number**           |                                                 |
+--------------------+-------------------------------------------------+
| **Office Phone     |                                                 |
| Number**           |                                                 |
+--------------------+-------------------------------------------------+
| **Fax Number**     |                                                 |
+--------------------+-------------------------------------------------+
| ## Email Address   |                                                 |
+--------------------+-------------------------------------------------+
| ## P.O.Box         |                                                 |
+--------------------+-------------------------------------------------+
| ## Address         |                                                 |
+--------------------+-------------------------------------------------+
| ## a) Street       |                                                 |
+--------------------+-------------------------------------------------+
| ## b) Village/City |                                                 |
+--------------------+-------------------------------------------------+
| #                  |                                                 |
| # c) Caza/District |                                                 |
+--------------------+-------------------------------------------------+
| ## d) Mouhafaza    |                                                 |
+--------------------+-------------------------------------------------+
| ## Type of s       |                                                 |
| ervices offered by |                                                 |
|  your organization |                                                 |
+--------------------+-------------------------------------------------+
| ## His             |                                                 |
| torical background |                                                 |
+--------------------+-------------------------------------------------+

+-------------------+-----------------------------+-----+-----+-------+
| ###               |                             |     |     |       |
| # PROJECT DETAILS |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| **Project         |                             |     |     |       |
| objective (State  |                             |     |     |       |
| the purposes of   |                             |     |     |       |
| the project)**    |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| **Number of       |                             |     |     |       |
| project           |                             |     |     |       |
| beneficiaries**   |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| **Items requested | **Item**                    | **  | **U | ####  |
| and cost (for     |                             | Num | nit | Total |
| more space, use   |                             | ber | C   |  Cost |
| an additional     |                             | of  | ost |       |
| page using the    |                             | U   | \   | **\$  |
| same format)**    |                             | nit | $US | USD** |
|                   |                             | s** | D** |       |
+-------------------+-----------------------------+-----+-----+-------+
| ##### Item #1     |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| ##### Item #2     |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| ##### Item #3     |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| ##### Item #4     |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #5           |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #6           |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #7           |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #8           |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #9           |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #10          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #11          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #12          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #13          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #14          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #15          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #16          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #17          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #18          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #19          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| Item #20          |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| ##### Total proj  |                             |     |     |       |
| ect cost in \$USD |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| ####              |                             |     |     |       |
|  [IMPORTANT]{.und |                             |     |     |       |
| erline}: *USAID f |                             |     |     |       |
| unds do not cover |                             |     |     |       |
|  taxation such as |                             |     |     |       |
|  Value Added Tax  |                             |     |     |       |
| (VAT) of 10% and  |                             |     |     |       |
| Customs Tax that  |                             |     |     |       |
| may be generated  |                             |     |     |       |
| from any procurem |                             |     |     |       |
| ent transaction u |                             |     |     |       |
| nder a grant. USA |                             |     |     |       |
| ID funds do not c |                             |     |     |       |
| over construction |                             |     |     |       |
| , infrastructure  |                             |     |     |       |
| or operational co |                             |     |     |       |
| sts, to maintain  |                             |     |     |       |
| project sustainab |                             |     |     |       |
| ility. USAID's Sm |                             |     |     |       |
| all Awards progra |                             |     |     |       |
| m funds projects  |                             |     |     |       |
| with a budget of  |                             |     |     |       |
| up to \$50,000.*  |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+
| **How will the    |                             |     |     |       |
| requested items   |                             |     |     |       |
| benefit your      |                             |     |     |       |
| organization?**   |                             |     |     |       |
+-------------------+-----------------------------+-----+-----+-------+

#### THIS SECTION IS FOR: [LEBANESE NON-PROFIT ORGANIZATIONS -- PRIVATE VOLUNTARY ORGANIZATIONS]{.underline}

#### DOCUMENTS TO SUBMIT WITH THE APPLICATION FORM

#### [NOTE]{.underline}: An Application Form submitted to USAID without [ALL]{.underline} the official documents requested below will [NOT]{.underline} be eligible for consideration.

+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
| * | **Check the left side box next to [only one]{.underline} of the  |
| * | five options below.**                                            |
|  |                                                                  |
| * |                                                                  |
| * |                                                                  |
+---+------------------------------------------------------------------+
|   | **1. If you are a Lebanese non-profit organization -- Private    |
|   | Voluntary Organization (PVO) -- the following official documents |
|   | are required (copies):**                                         |
+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
|   | **2. If you are a school belonging to a Lebanese non-profit      |
|   | organization -- Private Voluntary Organization (PVO), the        |
|   | following official documents are required:**                     |
+---+------------------------------------------------------------------+
| 1 |                                                                  |
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
| 9 |                                                                  |
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+---+------------------------------------------------------------------+
| 1 |                                                                  |
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+---+------------------------------------------------------------------+
|   | **3. If you are a dispensary belonging to a Lebanese non-profit  |
|   | organization -- Private Voluntary Organization (PVO), the        |
|   | following official documents are required:**                     |
+---+------------------------------------------------------------------+
| 1 |                                                                  |
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+---+------------------------------------------------------------------+
| 2 |                                                                  |
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
| 7 |                                                                  |
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+---+------------------------------------------------------------------+
| 8 |                                                                  |
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+---+------------------------------------------------------------------+
| 9 |                                                                  |
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+---+------------------------------------------------------------------+
|   | **4. If you are an orphanage belonging to a Lebanese non-profit  |
|   | organization -- Private Voluntary Organization (PVO), the        |
|   | following official documents are required:**                     |
+---+------------------------------------------------------------------+
| 1 |                                                                  |
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+---+------------------------------------------------------------------+
| 2 |                                                                  |
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
| 4 |                                                                  |
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+---+------------------------------------------------------------------+
| 5 |                                                                  |
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+---+------------------------------------------------------------------+
| 6 |                                                                  |
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+---+------------------------------------------------------------------+
| 7 |                                                                  |
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+---+------------------------------------------------------------------+
| 8 |                                                                  |
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+---+------------------------------------------------------------------+
| 9 |                                                                  |
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+---+------------------------------------------------------------------+
|   | **5. If you are an old age home belonging to a Lebanese          |
|   | non-profit organization -- Private Voluntary Organization (PVO), |
|   | the following official documents are required:**                 |
+---+------------------------------------------------------------------+
| 1 |                                                                  |
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+---+------------------------------------------------------------------+
| 2 |                                                                  |
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
| 4 |                                                                  |
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+---+------------------------------------------------------------------+
| 5 |                                                                  |
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+---+------------------------------------------------------------------+
| 6 |                                                                  |
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+---+------------------------------------------------------------------+
| 7 |                                                                  |
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| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+
| 8 |                                                                  |
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+

## 

**THIS SECTION IS FOR: [LEBANESE FAITH-BASED ORGANIZATIONS
]{.underline}**

#### DOCUMENTS TO SUBMIT WITH THE APPLICATION FORM

#### [NOTE]{.underline}: An Application Form submitted to USAID without [ALL]{.underline} the official documents requested below will [NOT]{.underline} be eligible for consideration.

+---+------------------------------------------------------------------+
| B |                                                                  |
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+---+------------------------------------------------------------------+
| * | **Check the left side box next to [only one]{.underline} of the  |
| * | four options below.**                                            |
|  |                                                                  |
| * |                                                                  |
| * |                                                                  |
+---+------------------------------------------------------------------+
|   | **1. If you are a school belonging to a Lebanese Faith-Based     |
|   | Organization (FBO), the following official documents are         |
|   | required:**                                                      |
+---+------------------------------------------------------------------+
| 1 |                                                                  |
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+---+------------------------------------------------------------------+
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+---+------------------------------------------------------------------+
| 3 |                                                                  |
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+---+------------------------------------------------------------------+
| 4 |                                                                  |
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+---+------------------------------------------------------------------+
|   | **2. If you are a dispensary belonging to a Lebanese Faith-Based |
|   | Organization (FBO), the following official documents are         |
|   | required:**                                                      |
+---+------------------------------------------------------------------+
| 1 |                                                                  |
| \ |                                                                  |
| . |                                                                  |
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+---+------------------------------------------------------------------+
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| l |                                                                  |
| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+
| 3 |                                                                  |
| \ |                                                                  |
| . |                                                                  |
| D |                                                                  |
| i |                                                                  |
| s |                                                                  |
| p |                                                                  |
| e |                                                                  |
| n |                                                                  |
| s |                                                                  |
| a |                                                                  |
| r |                                                                  |
| y |                                                                  |
| c |                                                                  |
| u |                                                                  |
| r |                                                                  |
| r |                                                                  |
| e |                                                                  |
| n |                                                                  |
| t |                                                                  |
| y |                                                                  |
| e |                                                                  |
| a |                                                                  |
| r |                                                                  |
| ' |                                                                  |
| s |                                                                  |
| b |                                                                  |
| u |                                                                  |
| d |                                                                  |
| g |                                                                  |
| e |                                                                  |
| t |                                                                  |
| . |                                                                  |
| [ |                                                                  |
| ل |                                                                  |
| ل |                                                                  |
| م |                                                                  |
| س |                                                                  |
| ت |                                                                  |
| و |                                                                  |
| ص |                                                                  |
| ف |                                                                  |
| ن |                                                                  |
| س |                                                                  |
| خ |                                                                  |
| ة |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| م |                                                                  |
| و |                                                                  |
| ا |                                                                  |
| ز |                                                                  |
| ن |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| س |                                                                  |
| ن |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| ح |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| ي |                                                                  |
| ة |                                                                  |
| ] |                                                                  |
| { |                                                                  |
| d |                                                                  |
| i |                                                                  |
| r |                                                                  |
| = |                                                                  |
| " |                                                                  |
| r |                                                                  |
| t |                                                                  |
| l |                                                                  |
| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+
|   | **3. If you are an orphanage belonging to a Lebanese Faith-Based |
|   | Organization (FBO), the following official documents are         |
|   | required:**                                                      |
+---+------------------------------------------------------------------+
| 1 |                                                                  |
| \ |                                                                  |
| . |                                                                  |
| O |                                                                  |
| r |                                                                  |
| p |                                                                  |
| h |                                                                  |
| a |                                                                  |
| n |                                                                  |
| a |                                                                  |
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| e |                                                                  |
| L |                                                                  |
| i |                                                                  |
| c |                                                                  |
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| n |                                                                  |
| s |                                                                  |
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| . |                                                                  |
| [ |                                                                  |
| ر |                                                                  |
| خ |                                                                  |
| ص |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| م |                                                                  |
| ي |                                                                  |
| ت |                                                                  |
| م |                                                                  |
| ن |                                                                  |
| س |                                                                  |
| خ |                                                                  |
| ة |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| ] |                                                                  |
| { |                                                                  |
| d |                                                                  |
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| = |                                                                  |
| " |                                                                  |
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| t |                                                                  |
| l |                                                                  |
| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+
| 2 |                                                                  |
| \ |                                                                  |
| . |                                                                  |
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| p |                                                                  |
| h |                                                                  |
| a |                                                                  |
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| a |                                                                  |
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| e |                                                                  |
| p |                                                                  |
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| v |                                                                  |
| i |                                                                  |
| o |                                                                  |
| u |                                                                  |
| s |                                                                  |
| y |                                                                  |
| e |                                                                  |
| a |                                                                  |
| r |                                                                  |
| ' |                                                                  |
| s |                                                                  |
| f |                                                                  |
| i |                                                                  |
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| a |                                                                  |
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| i |                                                                  |
| a |                                                                  |
| l |                                                                  |
| s |                                                                  |
| t |                                                                  |
| a |                                                                  |
| t |                                                                  |
| e |                                                                  |
| m |                                                                  |
| e |                                                                  |
| n |                                                                  |
| t |                                                                  |
| . |                                                                  |
| [ |                                                                  |
| ن |                                                                  |
| س |                                                                  |
| خ |                                                                  |
| ة |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| م |                                                                  |
| ي |                                                                  |
| ز |                                                                  |
| ا |                                                                  |
| ن |                                                                  |
| ي |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| س |                                                                  |
| ن |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| س |                                                                  |
| ا |                                                                  |
| ب |                                                                  |
| ق |                                                                  |
| ة |                                                                  |
| ل |                                                                  |
| ل |                                                                  |
| م |                                                                  |
| ي |                                                                  |
| ت |                                                                  |
| م |                                                                  |
| ] |                                                                  |
| { |                                                                  |
| d |                                                                  |
| i |                                                                  |
| r |                                                                  |
| = |                                                                  |
| " |                                                                  |
| r |                                                                  |
| t |                                                                  |
| l |                                                                  |
| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+
| 3 |                                                                  |
| \ |                                                                  |
| . |                                                                  |
| O |                                                                  |
| r |                                                                  |
| p |                                                                  |
| h |                                                                  |
| a |                                                                  |
| n |                                                                  |
| a |                                                                  |
| g |                                                                  |
| e |                                                                  |
| c |                                                                  |
| u |                                                                  |
| r |                                                                  |
| r |                                                                  |
| e |                                                                  |
| n |                                                                  |
| t |                                                                  |
| y |                                                                  |
| e |                                                                  |
| a |                                                                  |
| r |                                                                  |
| ' |                                                                  |
| s |                                                                  |
| b |                                                                  |
| u |                                                                  |
| d |                                                                  |
| g |                                                                  |
| e |                                                                  |
| t |                                                                  |
| . |                                                                  |
| [ |                                                                  |
| ن |                                                                  |
| س |                                                                  |
| خ |                                                                  |
| ة |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| م |                                                                  |
| و |                                                                  |
| ا |                                                                  |
| ز |                                                                  |
| ن |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| س |                                                                  |
| ن |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| ح |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| ي |                                                                  |
| ة |                                                                  |
| ل |                                                                  |
| ل |                                                                  |
| م |                                                                  |
| ي |                                                                  |
| ت |                                                                  |
| م |                                                                  |
| ] |                                                                  |
| { |                                                                  |
| d |                                                                  |
| i |                                                                  |
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| = |                                                                  |
| " |                                                                  |
| r |                                                                  |
| t |                                                                  |
| l |                                                                  |
| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+
|   | **4. If you are an old age home belonging to a Lebanese          |
|   | Faith-Based Organization (FBO), the following official documents |
|   | are required:**                                                  |
+---+------------------------------------------------------------------+
| 1 |                                                                  |
| \ |                                                                  |
| . |                                                                  |
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| l |                                                                  |
| d |                                                                  |
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| H |                                                                  |
| o |                                                                  |
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| l |                                                                  |
| i |                                                                  |
| c |                                                                  |
| e |                                                                  |
| n |                                                                  |
| s |                                                                  |
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| . |                                                                  |
| [ |                                                                  |
| ر |                                                                  |
| خ |                                                                  |
| ص |                                                                  |
| ة |                                                                  |
| د |                                                                  |
| ا |                                                                  |
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| ا |                                                                  |
| ل |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| ا |                                                                  |
| ي |                                                                  |
| ة |                                                                  |
| ب |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| م |                                                                  |
| س |                                                                  |
| ن |                                                                  |
| ي |                                                                  |
| ن |                                                                  |
| ن |                                                                  |
| س |                                                                  |
| خ |                                                                  |
| ة |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| ] |                                                                  |
| { |                                                                  |
| d |                                                                  |
| i |                                                                  |
| r |                                                                  |
| = |                                                                  |
| " |                                                                  |
| r |                                                                  |
| t |                                                                  |
| l |                                                                  |
| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+
| 2 |                                                                  |
| \ |                                                                  |
| . |                                                                  |
| O |                                                                  |
| l |                                                                  |
| d |                                                                  |
| A |                                                                  |
| g |                                                                  |
| e |                                                                  |
| H |                                                                  |
| o |                                                                  |
| m |                                                                  |
| e |                                                                  |
| p |                                                                  |
| r |                                                                  |
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| v |                                                                  |
| i |                                                                  |
| o |                                                                  |
| u |                                                                  |
| s |                                                                  |
| y |                                                                  |
| e |                                                                  |
| a |                                                                  |
| r |                                                                  |
| ' |                                                                  |
| s |                                                                  |
| f |                                                                  |
| i |                                                                  |
| n |                                                                  |
| a |                                                                  |
| n |                                                                  |
| c |                                                                  |
| i |                                                                  |
| a |                                                                  |
| l |                                                                  |
| s |                                                                  |
| t |                                                                  |
| a |                                                                  |
| t |                                                                  |
| e |                                                                  |
| m |                                                                  |
| e |                                                                  |
| n |                                                                  |
| t |                                                                  |
| . |                                                                  |
| [ |                                                                  |
| ن |                                                                  |
| س |                                                                  |
| خ |                                                                  |
| ة |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| م |                                                                  |
| ي |                                                                  |
| ز |                                                                  |
| ا |                                                                  |
| ن |                                                                  |
| ي |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| س |                                                                  |
| ن |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| س |                                                                  |
| ا |                                                                  |
| ب |                                                                  |
| ق |                                                                  |
| ة |                                                                  |
| ل |                                                                  |
| د |                                                                  |
| ا |                                                                  |
| ر |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| ا |                                                                  |
| ي |                                                                  |
| ة |                                                                  |
| ب |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| م |                                                                  |
| س |                                                                  |
| ن |                                                                  |
| ي |                                                                  |
| ن |                                                                  |
| ] |                                                                  |
| { |                                                                  |
| d |                                                                  |
| i |                                                                  |
| r |                                                                  |
| = |                                                                  |
| " |                                                                  |
| r |                                                                  |
| t |                                                                  |
| l |                                                                  |
| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+
| 3 |                                                                  |
| \ |                                                                  |
| . |                                                                  |
| O |                                                                  |
| l |                                                                  |
| d |                                                                  |
| A |                                                                  |
| g |                                                                  |
| e |                                                                  |
| H |                                                                  |
| o |                                                                  |
| m |                                                                  |
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| c |                                                                  |
| u |                                                                  |
| r |                                                                  |
| r |                                                                  |
| e |                                                                  |
| n |                                                                  |
| t |                                                                  |
| y |                                                                  |
| e |                                                                  |
| a |                                                                  |
| r |                                                                  |
| ' |                                                                  |
| s |                                                                  |
| b |                                                                  |
| u |                                                                  |
| d |                                                                  |
| g |                                                                  |
| e |                                                                  |
| t |                                                                  |
| . |                                                                  |
| [ |                                                                  |
| ن |                                                                  |
| س |                                                                  |
| خ |                                                                  |
| ة |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| م |                                                                  |
| و |                                                                  |
| ا |                                                                  |
| ز |                                                                  |
| ن |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| س |                                                                  |
| ن |                                                                  |
| ة |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| ح |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| ي |                                                                  |
| ة |                                                                  |
| ل |                                                                  |
| د |                                                                  |
| ا |                                                                  |
| ر |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| ع |                                                                  |
| ن |                                                                  |
| ا |                                                                  |
| ي |                                                                  |
| ة |                                                                  |
| ب |                                                                  |
| ا |                                                                  |
| ل |                                                                  |
| م |                                                                  |
| س |                                                                  |
| ن |                                                                  |
| ي |                                                                  |
| ن |                                                                  |
| ] |                                                                  |
| { |                                                                  |
| d |                                                                  |
| i |                                                                  |
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| = |                                                                  |
| " |                                                                  |
| r |                                                                  |
| t |                                                                  |
| l |                                                                  |
| " |                                                                  |
| } |                                                                  |
+---+------------------------------------------------------------------+

**[Note to the applicant]{.underline}**: All application forms submitted
to USAID will be evaluated against USAID's evaluation criteria and are
subject to the availability of funds. USAID will notify applicants of
the acceptance or rejection of their application form; therefore,
applicant follow up by contacting USAID is not required.

## 

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