U.S.

EMBASSY DEMOCRACY COMMISSIOM SMALL GRANT

PROGRAM
APPLICATION FORM
aSS-s saelCos demokratiis komisiis mcire grantebis programa

ganacxadis forma
DEADLINE: JANUARY 16, 2012, 6 P.M. FILL OUT THIS FORM IN ENGLISH
sabuTebis miReba 2012 w. 16 ianvris 6 sT.mde.
ganacxadi miiReba dabeWdili da mxolod inglisur enaze

Information About Organization

informacia organizaciis Sesaxeb

General Information:
zogadi informacia:
Organization name (in Georgian)
organizaciis dasaxeleba (qarTul
enaze):
Organization name (in English):
organizaciis dasaxeleba (inglisur
enaze)
Organization Representative:
Organizaciis warmomadgeneli
Legal address of the organization:
organizaciis iuridiuli misamarTi:
Physical address of the organization:
organizaciis fizikuri misamarTi:
Web address:
organizaciis veb-gverdis misamarTi:
Contact information: Tel, Mobile,
Fax, E-mail:
organizaciis sakontaqto informacia:
telefoni, faqsi, mobiluri, el-fosta

Information on registration:
informacia organizaciis registraciis Sesaxeb:
Date of registration:
registraciis TariRi:
Place of registration:
registraciis adgili:

Registration number:
registraciis nomeri:

DETAILED INFORMATION
dawvrilebiTi informacia proeqtis Sesaxeb

Name of project:
proeqtis saxelwodeba:

Amount requested
moTxovnili Tanxa
grantis maqsimaluri Tanxa $24,000.

Project period
proeqtis vadebi
proeqtis dawyeba SesaZlebeli iqneba misi Semotanidan 6 TveSi. proeqtis maqsimaluri xangrZlivobaa 1
weli.

Executive summary of the project

proeqtis reziume
mokled-- TiTo winadadebiT-- warmoadgineT proeqtis reziume: proeqtis dasaxeleba, mizani, da
mosalodneli Sedegebi.
miuTiTeT gancxadebaSi aRniSnul romel prioritetul Temas miesadageba Tqveni proeqti.

Project Goals and Justification

proeqtis miznebi da dasabuTeba
es nawili proeqtSi yvelaze mniSvnelovan aspeqts warmoadgens. gaiTvaliswineT Semdegi SekiTxvebi:
ra mizans emsaxureba proeqti? ratom unda dafinansdes swored Tqveni proeqti? ra mniSvneloba aqvs
mis ganxorcielebas qveynisaTvis da rogor Seuwyobs igi xels demokratiuli Rirebulebebis ganviTarebas?
ra konkretuli problemis mogvarebas elodebiT am proeqtis ganxorcielebis Sedegad?

Detailed Description of the Project and Activities

proeqtis detaluri aRwera da RonisZiebebi

Tanmimdevrulad mogvawodeT informacia RonisZiebaTa saxeobebze. magaliTad: mrgvali magida,

konferencia, seminarebis cikli, publikaciebi da a.S. aRniSneT TiToeuli RonisZiebis Tema da mizani,
xangrZlivoba, miznobrivi jgufebi, maTi SerCevis meTodi, monawileTa raodenoba da kategoriebi.
publikaciisaTvis miuTiTeT Temebi, moculoba, tiraJi, perioduloba da gavrcelebis saSualebebi.

ACTIVITY TIMETABLE
RonisZiebebis kalendaruli ganrigi
Activity
RonisZiebebis
dasaxeleba

II

III

IV

VI

VII

VIII

IX

XI

XII

1
2
3
4
5

Project beneficiaries
miznobrivi jgufebi/benificiarebi
miuTiTeT proeqtiT gaTvaliswinebuli miznobrivi jgufebi da raodenoba.

Expected Results
mosalodneli Sedegebi
aRwereT proeqtis mokle da grZelvadiani Sedegebi, moiyvaneT raodenobrivi da ricxobrivi
maCveneblebi, daasaxeleT ra konkretuli problema gadaiWreba proeqtis farglebSi.

Sustainability of Project
sicocxlisunarianoba
aRwereT am proeqtis mdgradi ganviTarebis perspeqtivebi da organizaciis samomavlo gegmebi.

Logical Framework for Monitoring and Evaluation (see the example below)
logikuri CarCo monitoringisa da SefasebisaTvis (nimuSi ixileT qveviT)

Objectively verifiable indicators

obieqturad dadasturebadi
indikatorebi

Sources and means for

verification

Assumptions and risks

daSvebebi da riskebi

wyaroebi da dadasturebis
saSualebebi

Goal: (mizani)
gaumjobesebuli
inglisuri enisa da
kompiuteris unarebi
iZulebiT
gadaadgilebuli
bavSvebisTvis

samizne studentebis %,
romlebmac gaaumjobeses
testis Sedegebi minimum 20%iT

testis Sedegebi (saboloo da

sawyisi testebis Sedegebis
Sedareba)

studentebis %, romlebic
asaxeleben swavlebis axal
midgomebs rogorc ,,ukeTess da
,,advilad saswavls.

studentebis kvlevis
Sedegebi

studentebis raodenoba, vinc

miiRo kompiuteris Sesaswavli
saxelmZRvaneloebi qarTul
enaze

gadacemis damadasturebeli
dokumenti

Catarebuli treningebis
raodenoba;
monawileTa raodenoba

treningebis dRis wesrigi,

angariSebi, monawileTa
siebi.

maswavlebelTa raodenoba,
romelTac gaecnoT da gadaecaT
masalebi swavlebis axal
meTodologiaze

saprezentacio masala

naTargmni da gavrcelebuli
wignebis raodenoba

monitoringisa da progresis
angariSebi

Expected Results:
(mosalodneli
Sedegebi)

1. maswavleblebma
praqtikaSi danerges
inglusri enisa da
kompiuteris swavlebis
ukeTesi meTodologia
2. kompiuteris
saxelmZRvaneloebi
qarTul enaze
xelmisawvdomia
moswavleTaTvis

Activities:
(aqtivobebi)

1.1. samizne
maswavlebelTaTvis
treningebis Catareba
1.2. inglisuri enis
swavlebis axali
meTodologiis gacnoba
2.1. kompiuteris
Sesaswavli
Tanamedrove
saxelmZRvaneloebis
Targmna qarTul enaze
da maTi gavrceleba
samizne moswavleebs
Soris

ganaTlebis
saministro krZalavs
saswavlo programaSi
da swavlebis
meTodologiaSi
cvlilebebis Setanas
(riski)

maswavleblebi
gamoxataven survils
da gamoyofen
dros ,maswavlebelTa
treningSi
monawileobisaTvis
(daSveba)

dabali xarisxis
Targmani (riski)

PROJECT BUDGET
proeqtis biujeti
/$/-- biujeti warmoadgineT aSS-s dolarebSi, laris Sesabamisi kursis miTiTebiT
PROJECT BUDGET
biujetis cxrilis nimuSi
Budget details for Project Activities:

Item/ muxlis

Details of Budget/

dasaxeleba

sacalo
Rirebuleba/raodenoba

Amount
($)/saerTo
Rirebuleba

U.S. Embassy/
saelCos
fondidan
moTxovnili
Tanxa

Other donor/
sxva fondebidan
moTxovnili/miRebul
i Tanxebi

magaliTad:
kompiuteri
(tipi, modeli)
sastumro
monawileebisaTvis

$500X5 kompiuteri
30 monawileX$30
dReX5dRe

TOTAL

$2,500

$1,500

$1,000

$4,500

$4,500

$7,000

$6,000

$1,000

Organizations In-kind Contribution:

organizaciis wvlili proeqtSi
Item
muxli

Description
Rirebuleba/ raodenoba

($)
Tanxa

Budget details for project activities

biujetis dasabuTeba
detalurad daasabuTeT biujetis danaxarjebi. biujetis yvela muxli enda Seesabamebodes proeqtiT
gaTvaliswinebul RonisZiebebs da gamarTlebuli unda iyos. magaliTad: kompiuterisa da printeris
SeZena mxolod erTi seminamarisaTvis ar aris gamarTlebuli.
ar dafinansdeba Semdegi muxlebi:

sxvadasxva da gauTvaliswinebeli xarjebi

premiebi, prizebi, zeimebi da sxva gasarTobi RonisZiebebi

alkoholuri sasmelebi, yvavilebi da musikaluri gaformeba

limitirebulia dafinanseba Semdegi muxlebisaTvis:

kvebaze moTxovnili Tanxa ar unda aRematebodes saerTo biujetis 10 procents.

xelfasebi da honorarebi gadaexdebaT mxolod proeqtSi dasaqmebul pirebs, maTi

movaleobebisa da samuSao ganakveTis safuZvelze. saxelfaso fondi ar unda aWarbebdes
saerTo biujetis 30 procents da unda Seicavdes saSemosavlo gadasaxads.

IMPLEMENTATION TEAM
proeqtis SemsrulebelTa jgufi

daasaxeleT proeqtis ZiriTadi Semsruleblebi, maTi Tanamdeboba, movaleobebi da sakontaqto

informacia. garda amisa, proeqts unda daurToT am pirTa biografiuli monacemebi (CV , Resume) .

Name

saxeli, gvari

Position Title and Description

Tanamdeboba da movaleobebi proeqtis farglebSi

Contacts:
tel/el-fosta

BACKGROUND

informacia organizaciis saqmianobis Sesaxeb

mokled aRwereT organizaciis misia da amocanebi

warsuli da mimdinare saqmianoba
Sesrulebuli proeqtebi, donorebi da dafinansebis raodenoba
mniSvnelovani miRwevebi

OTHER USG FUNDING

informacia aSS-s mTavrobis (aSS-s saelCo, USAID) sxva grantebis Sesaxeb
gisargebliaT Tu ara warsulSi amerikuli dafinansebiT, da amJamad Tu gaqvT ganacxadi gakeTebuli sxva
amerikul sagranto programaze.

SUPPORT AND CONFIRMATION LETTERS

sarekomendacio werilebi

sarekomendacio werilebi (1-3) sasurvelia mogvawodoT inglisur enaze. Tu rekomendacia qarTul

enazea, daurTeT inglisuri Targmani (notariuli damowmebis gareSe).

APPLICATION CHECKLIST
saaplikacio paketis CamonaTvali

Mandatory:

savaldebuloa:

One copy of the application form (printed in English)

ganacxadis forma (araumetes 9 gverdisa, inglisur enaze)

Copy of registration documents (in Georgian)

organizaciis registraciis mowmobis asli (qarTul enaze)

Copy of Statutes (in Georgian)

organizaciis wesdebis asli (qarTul enaze)

CVs of the Project Team (in English)

proeqtSi monawileTa CV, biografiuli monacemebi ( inglisur enaze)
Recommendation letters
sarekomendacio werilebi 1-3; (inglisur enaze an qarTul enaze Targmanis darTviT).

Supplementary:
damatebiTi, ara-savaldebulo informacia:

Any print material by or about the organization

organizaciis mier gamoSvebuli an masze dawerili publikaciebi

Organization presentational leaflets

organizaciis saprezentacio bukleti

Confirmation letters from donors on matching funds

informacia damatebiT safinanso wyaroebze da donorTa Tanxmobis werilebi

Information about project partners and partnership agreements

damatebiTi informacia proeqtis partniorebze da partnioruli xelSekrulebebi

Project Application form on CD or floppy disk

ganacxadis forma disketaze an CD-ze.
Please send the application package or hand-deliver it to the following address:
saaplikacio paketi gamogzavneT an datoveT aSS-is saelCos misaRebSi Semdeg
misamarTze:

DemCom Small Grant Program

Public Affairs Section
U.S. Embassy Tbilisi
11 George Balanchine Street,
Tbilisi 0131, Georgia
SeniSvna: ganacxadis Sevsebis dros SegiZliaT waSaloT
enaze.

demokratiis komisiis
mcire grantebis programa
aSS-is saelCos sazogadoebasTan
urTierTobis ganyofileba
jorj balanCinis q.11
Tbilisi 0131, saqarTvelo
mocemuli ganmartebebi/instruqciebi qarTul

konsultaciisaTvis daukavSirdiT sofio gegeWkors (2-277-601), nino gaguas (2-277-628), an giorgi

gabunias (2-277-926).