The FedEx Award for Innovations in Disaster Preparedness Submission Form I.

Contact Information
Name: Organization: Address: Telephone: Title:


II. Basic Information on Project
Title of Project: ________________________________________________________________________ Location (please include all relevant information: regions, countries, districts/provinces, cities, etc): _____________________________________________________________________________________ Scale (choose one): Local/Community State/Provincial/Sub-national National Regional International

Target Population(s): Number of Beneficiaries: Partners: Funders/Donors: Total Funding: Website:

III. Project Details
1. Intervention background and goals and objectives (maximum 250 words) Please describe the intervention and its goals and objectives. Include details on the intervention’s timeline.

2. Please describe the project’s key activities (maximum 250 words) Please describe the intervention’s main activities.

3. Please explain why the intervention is an innovation. Provide evidence in the following areas: (maximum 750 words)  Effectiveness/evidence of success: Evidence is provided demonstrating the impact of the intervention to increase awareness; build capacity and knowledge; promote community involvement; foster collaboration between civil society, local governments and the private sector; and/or mainstream disaster preparedness activities.  Sustainability: Information is provided describing the steps taken or mechanisms put in place to ensure that the intervention will be socially, financially and environmentally sustainable in the long-term.  Equitable outcomes for women and men: Evidence is provided to document that the intervention enables or facilitates the participation of, and results in, equitable benefits for both women and men.  Efficiency/cost-effectiveness: Evidence is provided demonstrating the cost-effectiveness of the intervention compared to traditional disaster preparedness interventions.  Replicability/adaptability: Information is provided documenting how the intervention has been or could be replicated or adapted in other settings; or how the intervention could expand operations based on demonstrated success in its pilot or phase one areas of operation.

4. Challenges & Lessons Learned (maximum 250 words) Please describe the main challenges or obstacles you faced or are facing in this intervention and how they were addressed. What are the most important lessons that a reader should take from this experience?

5. Have you held or do you plan to hold a consultative process with target groups in which you gather feedback? If yes, please explain. (maximum 150 words)

6. Please provide a testimonial from someone who has benefited from this intervention. (maximum 200 words)

7. If selected, how will your organization use the funds? (maximum 150 words)

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