The Embassy of the United States of America

DEMOCRACY AND HUMAN RIGHTS FUND

PROJECT APPLICATION FORM

***Attention: Democracy and Human Rights Coordinator***

*310 Avenue des Aviateurs, Kinshasa/Gombe, Rép. Démocratique du Congo*

*Tel: (243) 81-225-5872 ext.2144 e-mail:
[KinshasaSSHF_DHRF@state.gov](mailto:KinshasaSSHR_DHRF@state.gov)*

**[Warning]{.underline}**

**This form is distributed free of charge by the Embassy of the United
States of America.\
[Under no circumstances can it be sold]{.underline}. It can be
photocopied freely or downloaded from the Embassy website,
http://kinshasa.state.gov/. An electronic copy will be sent to whoever
requests it by sending an email to the above address. You may add
additional sheets of paper to this form if necessary. The Embassy also
accepts applications received without this application form, as long as
they contain the information required in the form. Anyone seeking to
sell this form or to use it for any advantage or personal gain will be
subject to prosecution.**

**[Criteria]{.underline}**

Acceptable activities or proposals are those which promote: (a) Human
Rights: education, human rights NGO start-up, prisoner rights, prison
conditions; (b) Law: distribution of laws and constitutions, legal
association start-up, legal aid; (c) Justice: training of court
officials, improving the judiciary's efficiency; (d) Civic Education:
journalist education on a free press, journalist assistance start-ups;
(e) Women's and Children's Rights: education, counseling and legal
support for abused women, prevention of the trafficking of women and
children; (f) Elections: assistance with election monitoring; (g)
Conflict Resolution: activities promoting tolerance among sectors of
society; (h) Civic Participation: protecting and enabling the growth of
civil society organizations, support their participation in democratic
decision-making, encourage a civic culture that supports democratic
processes, participation in political and civic life, and civic virtues
of tolerance, pluralism, and respect for individual rights.

Indigenous organizations working in these areas are welcome to complete
this form and return it to the Embassy. Applications are accepted year
around. Selection of projects takes place normally between January and
July. Please note that due to the large number of applications received,
it is not always possible to respond to your application immediately. We
will contact you by telephone or email if we need additional information
from you. Normal funding level: \$2,000 - \$10,000, sometimes less or
more.

**[Association/organization/group applying for funds]{.underline}**

**Name of the association**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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Year established: \_\_\_\_\_\_\_\_\_\_\_\_\_\_ Number of members:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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**Name of Contact**
(1):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title within the organization:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ E-mail:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Name of Contact**
(2):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title within the organization:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Telephone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ E-mail:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Please provide brief description of the organization: location, funding
source(s) with estimated amounts, prior management experience:
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Has this organization received previous DHRF grants? Yes / No -
Year(s):\_\_\_\_\_\_\_\_\_\_\_\_

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**[Description of project for which funding is requested]{.underline}**

Description of the Activity: objective of activity, how does the
activity promote human rights or support political pluralism, how is a
more open democratic society promoted; calendar; who will be
responsible, ...

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**[Financial Information]{.underline}**

Please provide detailed budget showing why the requested funds are
necessary and how they will be spent to complete this project. Be
specific and list quotations for services requested, materials,
equipment, labor, travel, and printing, etc., listing separately: (a) a
breakdown of the contribution requested from the Embassy, (b) an
estimate of your organization's contribution, and (c) the contribution
of other donors, if any. Include the quantity and estimated cost of each
item. If possible, attach [pro forma invoices]{.underline} from vendors
for the planned expenses. (Attach pages if space provided is not
sufficient or format is not appropriate.)

**Embassy Contribution**:

([Item)]{.underline} ([Qty)]{.underline} ([Unit Cost]{.underline})
([Total Cost]{.underline})

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**Total contribution requested from Embassy**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\$/FC

**Contribution from your organization** (cash, labor, materials, etc.):

([Item)]{.underline} (E[stimated value]{.underline})

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**Total contribution from your organization**:
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**Description and amount of contributions from other donors**, if any:

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**Total contribution from other donors**:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\$/FC

Signature: Date: