CPC FUNDING PROPOSAL APPLICATION FORM FOR ORGANIZATIONS

Organization Application - English

Organization Information

Organization Name *

Please enter your Organization Name.

ID *

Please enter your ID.

Year Established *

Please enter your Year Established.

Legal Address of Organization *

Please enter the legal address of the organization.

Physical Address of Organization *

Please enter the physical address of your organization.

Web address

Please enter your web address.

Organization representative/full name *

Please enter your organization representative/full name.

Email *

Please enter your email.

Phone *

Please enter your phone number.

Language Spoken by Contact Person *

Please enter your spoken language.

Organization's Mission Statement *

Please enter your organization's mission statement.

Description of Organization: Provide brief history of organization and programs *

Please enter your organization's description.

Proposed Project for IWA Funding

Project Title *

Please enter your Project Title.

Project Description: Please describe briefly the project you are applying for IWA funding *

Please enter your project description.

What is the community impact? *

Please enter your response for "What is the community impact?".

Funding Request and Budget in GEL *

Please enter your Funding Request and Budget in GEL.

When do you expect the project to start and to complete/end?

Start *

Please enter your Start.

End *

Please enter your End.

Please detail below any funding you’ve already secured or being secured for this project. (e.g. other donors, how much and which part of the project is to be supported?)

Please enter the funding you have already secured.

Additional information if needed

Please enter your additional information.

By typing your name and the date here, you verify that the information above is all correct to the best of your knowledge.

Confirm that the information above is correct.

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Bank Information

Bank: TBC Bank
Account Name: International Women's Association Georgia
IBAN: GE82TB7525136080100008
SWIFT/BIC: TBCBGE22

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