FUNDING APPLICATION
Contact Information
Full Legal Organisation Name
Street Address
City
Province
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Eastern Cape
Free State
Gauteng
Kwa-Zulu Natal
Limpopo
Mpumalanga
North West
Northern Cape
Western Cape
Postal Code
Organisation Website
Organisation Executive Director or Chief Executive Officer
Title
Mobile Phone Number
E-Mail Address
Project Contact Person
Title
Mobile Phone Number
E-Mail Address
Organisation Information
Section 18A or NPO?
Yes
No
Other
Year Established
Do you have Audited Financial Statements?
Yes
No
If 'No", do you have a Fiscal Host?
Yes
No
Fiscal Host name (if applicable)
Fiscal Host address
Total Organisation Budget
Total # of Board Members
Total # of Staff
Total # of Volunteers
Organisational Mission Statements
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Brief Description of Organisation
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Population Served
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FUNDING APPLICATION
Proposal Request
Program / Project Name
Total Program Budget
Requested Amount
Percent of Total Budget
Focus Area of Request
Please Select
Biomedical Equipment
Food Security
Gender Based Violence
Media Partners
Other
If other please explain:
Grant start period
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/
Month
/
Day
Year
Date
Grant end period
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Month
/
Day
Year
Date
Geographic Area Served
Geographical Demographic
Rural
Urban
Peri-Urban
Project Objectives and Activities
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Due to the number of requests received, please expect a response from us after 10 working days
Open Society Foundation of South Africa
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