ATTACHMENT A: LETTER OF INTEREST (LOI) TEMPLATE

Instructions

All applicants submitting a Letter of Interest (LOI) must complete this form. Please limit your
responses to the questions in Section II to 3 pages. All applicants must sign and date this form
as requested in Section IV. Unsigned LOIs will be considered incomplete.

Section I: Project Information

Please input complete responses for each section of the table below.

1. Project title:

2. Name of applicant organization:

3. Signatory/organization
representative:

4. Contact information for the Address:

applicant organization and the
signatory Phone:
Email:
Fax:

5. Project duration: ____years ____months

6. Country of project location:

7. Category of funding (choose Delivery and Expansion

one): Innovation and Knowledge

8. Have you received funds No

previously from the USAID Child
Blindness Program? Yes
 9. Type of organization (choose Non-U.S. based
one)
U.S. based

10. Please provide a brief summary of your project in 300 words or less in this box:

Section II: Project Description

1. Situational Assessment

Describe the problem you are seeking to address and the local issues and conditions in your
project area. This Situational Assessment must focus on the specific problem(s) you are
addressing and the local conditions in your project area. Please only provide verifiable
information and data that is relevant to your project.

2. Proposed Solution and Rationale

Describe your proposed solution to the problem. Provide a clear rationale and link between the
proposed solution(s) and your Situational Assessment.

3. Project Objectives, Activities and Results

Using the table below, briefly outline your projects objectives, the activities you propose to
undertake for each objective, the implementation timeline and your proposed results. The
directions included in each column are intended to assist you to complete the table.

Project Objectives, Activities and Results

Objectives/Proposed
Actions/Activities Results Timeline
Solution(s)
Directions: State clearly Directions: Name the key Directions: List the results Directions:
the solution you propose actions to be implemented you expect to achieve Indicate the
to implement to address to achieve your proposed which directly contribute to duration of the
the problem as identified solution. the solution to the problem activity (for
in your situation identified. example, 2
 assessment. weeks, 3
months, etc.)

4. Adherence to CBP Funding Priorities

Depending on the grant category to which you have chosen to apply (Delivery & Expansion or
Innovation & Knowledge), please describe how your project adheres to CBP funding priorities
as described in Section II of the RFA.

5. Management and Staffing

Describe how the proposed project will be effectively managed. Identify key personnel and
provide a brief overview of their responsibilities and expertise under this project. If you have
partners, briefly describe the roles and responsibilities of each organization.
Section III: Budget

Please complete the table below. Please provide all cost information in United States Dollars. Note, that although this template is
designed for a two-year grant, your project may be shorter. You should base your budget on your proposed start and end dates.
These are sample cost categories and some of them may not be applicable to all organizations or your project. Only fill out those
categories that apply to your specific proposed project.

PROJECT TOTAL
GRANTS FUND COST SHARE (Grant+Cost Share)

Cost Category Year 1 Year 2 TOTAL Year 1 Year 2 TOTAL Year 1 Year 2 TOTAL

TOTAL SALARIES

TOTAL STAFF FRINGE BENEFITS

TOTAL CONSULTANTS

TOTAL TRAVEL AND TRANSPORTATION

TOTAL TRAININGS, WORKSHOPS

TOTAL EQUIPMENT AND SUPPLIES

TOTAL OTHER DIRECT COSTS

TOTAL INDIRECT COSTS*

TOTAL BUDGET

*Not all organizations have indirect costs. Do not include indirect costs if you do not have an established audited indirect cost rate.
Section IV: Acknowledgement

Please complete the table below and provide the signature of the authorized
signatory/representative of your organization.

Submitted by:

On behalf of the applicant organization identified in Section I, Project Information, of this

Letter of Interest Form, I hereby certify that to the best of my knowledge, this Letter of
Interest in its entirety contains only true and current information:

Name:

Title:

Signature:

Date: