Application form

Category 2: Request for a grant for organizational core funding to build institutional capacity, financial sustainability and long-term development

  • This application form and all accompanying documents are to be completed in English.

  • The application form (including the project budget) must be submitted by July 1st 2012. Other necessary documents should be in our office by July 10th 2012.

  • Please indicate all amounts in Euros (€). Use rounded amounts and do NOT use dots and commas. Example: 8000 (eight thousand).

  • At the end of this form (under step 8 - Enclosures) you will need to submit a Word file with the budget, specification of salaries and, if necessary, balance sheets.
    You can download this Word file now or wait until step 8.

1. Applicant

Name of the organization
Address (street) number
Postal code; city or town
P.O. Box (optional)
Postal code of P.O. Box; city or town of P.O. Box  (optional)
Country
Phone number (incl. country and area code)
Fax number (incl. country and area code)  (optional)
Email
Website  (optional)
Managing Director or Chief Professional Officer
Accountant or bookkeeper of the organization  (optional)
Associated with any governmental agency or public authority?
 
 

2. Contact person

First name
Family name
Gender
Direct phone number (incl. country and area code)
Direct fax number (incl. country and area code)  (optional)
Email address (for confirmation email)
 

3. Mission and activities

Please describe briefly your organization and its mission (maximum 100 words):



Please describe your organization's activities and/or projects over the past three years
(maximum 150 words):



Please describe briefly the activities/projects that your organization intends to carry out
in the coming year (maximum 150 words):

Please give a description of your organization’s target group, and
what the size is of the target group (maximum 50 words):

4. Structure of your organization

Please describe the structure of your organization (maximum 200 words)

How many employees do you have (leadership, project management, administrative, volunteers)?
(maximum 100 words)
Do you own your own office?
If not, how much is your rent per year?
To whom do you pay your rent?

5. Request of subsidy for core-business and corefunding

Why do you need core funding of the JHF? (maximum 100 words):

What would you like to achieve?

Be aware that category 2 grants are not intended to fund general organizational
deficits of the past. (maximum 100 words):

6. Total budget, requested amount of the JHF, co-funding, own contribution

Please note: only in very rare instances will JHF fund an organization where JHF is the sole funding source.

  Amount in Euro (€)
Total budget of the organization
For which period do you request core funding from the JHF?  
Start
End

Specify the expected income for the coming year in the table below:
Amount in Euro (€)
Amount requested from the JHF [maximum is 50000 Euro]
Contribution from your own organization

Third party/parties funding

Name(s) of the organization(s):


Amount in Euro (€)
1.
2.
3.
4.
5.
6. Yields of sales
7. Contributions & fees
8. Other income (please specify)
    		 
9. Other income (please specify)
    		 
10. Other income (please specify)
    		 
11. Other income (please specify)
    		 
12. Other income (please specify)
    		 

7. Bank account details

Please fill in all requested items. Note that we can only transfer money to a Euro (€) bank account.

BIC beneficiary bank (SWIFT)
IBAN or account number of beneficiary
Exact name of beneficiary as known by the bank
Postal code and city of beneficiary
Country of beneficiary
Name of bank of beneficiary

8. Enclosures

Exhibit A:

If you have not already done so, please download the Word file with the total budget of your organization for the coming year and a specification of the salaries and if necessary the balance sheets.

Save this file to your computer's hard disk, and fill in the budget, salaries specification, and if necessary the balance sheets. Then select the completed file here:

Exhibit B:

Please send the following documents by regular mail:

1. Annual financial reports for the past three years (2009, 2010 and 2011).
  • These financial reports must include a balance sheet, a profit & loss account per year, and explanatory notes.
  • If the original document was written in a language other than English, it must be translated into English
  • Even if you have already sent the annual financial reports to our office in the past, please send them again.
2. A charter or articles of association of your organization;
3. A listing of your organization in the official public register;
4. If available: a published annual report, or its equivalent;
5. If available: an auditor's report.

Please note that:
  • The documents must be in our office by July 10th 2012.
  • If you have applied before and no legal changes have taken place, it is not necessary to send items 2 and 3 again.
  • When sending the documents, do not forget to note the name of your organization (the same name you use in the application form).
Our mailing address is:

Dutch Jewish Humanitarian Fund
P.O. Box 11646
2502 AP The Hague, The Netherlands

9. Print

Please review the data.

Before you submit your application, print the filled-out form for your own archive.

10. Sign & submit

The undersigned affirms that the form has been completed truthfully.

The undersigned is aware of the stipulations in the Disbursement Regulations for the Dutch Jewish Humanitarian Fund.

The undersigned agrees that the Dutch Jewish Humanitarian Fund may request information from any co-financing parties of the project and/or third parties, as required for proper evaluation of the application.



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