DEMOCRACY COMMISSION SMALL GRANTS

Public Affairs Section

U.S. Embassy Bucharest, Romania

**APPLICATION FORM**

*The Application Must Be Submitted in English*

*Please type or print*

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Name of the project:

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Name of the organization (in English):

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Name of the organization (in original language):

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Address:

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Phone and fax numbers; e-mail address:

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Represented by (name, title):

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Background of the representative (please state the representative's
title and background and attach 1 page CVs of the people who will be
engaged in the project):

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Background on the organization (please attach a scanned copy of the
registration papers):

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Any previous U.S. Government or Democracy Commission Small Grants
funding:

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Project dates:

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Amount requested (in US\$):

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Project description:

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Project purpose (what goals will be achieved and how the results will be
determined/measured):

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Project Justification (please describe the need or problems the project
will solve and the target groups):

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Project Sustainability:

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Detailed description of the project activities:

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Detailed budget (use extra sheets if necessary):

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How will you meet the program and financial reporting requirements
(e.g., who will prepare the financial report?):

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Other sources of support for this project (including in-kind
contributions of the applicant organization):

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Other organizations you applied to with the same project and status of
your application:

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City, date Signature of Applicant