Executive Summary (UP TO 1 PAGE)
Project Name	The Project for
Organization Name (ENGLISH, AS REGISTERED)
Organization Name (ARABIC)
Project Location	Governorate: Municipality: District: Project location URL:
Total Requested Budget	(JOD)
(USD) *1 USD = 0.708 JOD
Sector(s)/ Focus Area(s)	☐ Education ☐ Healthcare ☐ Vocational training ☐ Waste management ☐ Water ☐ Disability ☐ Renewable energy ☐ Community development ☐ Others (please describe : )
Nature of the project	☐ Installation of new equipment ☐ Replacement of old equipment ☐ Rehabilitation of facility ☐ Construction of facility
Objective of the Project	[Example] By providing one ultrasound device to the ABC Hospital in Amman, the project aims to improve the quality of medical services for the under-served area of xx—including Syrian refugees and Palestinian refugees—and thereby contribute to improving the health of the local population.
Summary of Planned Activities and Outcome	[Example] After receiving the grant, we will procure the ultrasound within 5 months and place it in the gynecology department. 2 doctors will provide medical services using the ultrasound. Every 6 months there will be a maintenance check. Approximately 12,700 people per year—including 2,200 who until now had to be referred to other medical institutions—will be able to receive rapid and accurate examinations and diagnoses of organs such as the heart, liver, kidneys, and uterus, as well as blood vessels, using the ultrasound diagnostic device at the hospital. This will enable the early detection of a wide range of diseases and conditions among the hospital’s patients, particularly those from low-income groups.
Number of Beneficiaries	People*Estimated number of direct beneficiaries
Project Duration	Months*Period required to complete the installation of equipment or the construction/rehabilitation of facility. Duration should be up to 12 months.
Date of Submission	Select

*Up to 1 page for the executive summary

PROJECT PROPOSAL
(1) Title of the project	The Project for
(2)Requested budget	(JOD)
(USD) *1 USD = 0.708 JOD
(3) Project site	Governorate	Select
Municipality
District / camp
Total population of the site
Refugee population (if any)
Google map URL of the exact location
Status of building	Select
Status of land	Select
(4) Nature of the project	☐ Installation of new equipment ☐ Replacement of old equipment ☐ Rehabilitation of facility ☐ Construction of facility
(5) Target group(s)	☐ Poverty ☐ Children ☐ Youth ☐ Women ☐ Elderly ☐ Unemployed ☐ People with disabilities ☐ Syrian refugees ☐ Palestinian refugees ☐ Other refugees ☐ Others (please specify: )
(6) Problem statement and background information *Please describe the current situation of project site. Outline what the problem is, why it is a problem, who are affected. Use numbers and data where possible. Max 15 lines
(7) Applicant’s response to the problem *Please describe initiatives by the applicant to address the above challenges, and indicate why you cannot resolve problems on your own and you need assistance of the GGP. Use numbers and data where possible. Max 10 lines.
(8) Project outline and objectives *Please summarize goals, objectives and main activities of the project. Use numbers and data where possible. Max 15 lines.
(9) Project component and expected beneficiaries per year *Please list the items needed and identify beneficiaries before and after the GGP Project for each item.	Item (Qty)	Current number of beneficiaries (refugees/women etc)	Estimated number of beneficiaries after GGP (refugees/women etc)
[Example] Ultrasound machine	10,000 (1,200 women/ 6,500 refugees)	12,700 (1,800 women/ 7,500 refugees)
TOTAL
Comments (How did you calculate?)
(10) Implementation and management of the procured items *Please explain how you will implement the project and conduct maintenance of the items.	Item (Qty)	Staff to implement the project	Frequency of regular maintenance
[Example] Ultrasound machine	2 doctors	Once every 3 months
Comments (How will you cover the cost of maintenance/replacement? Are you planning to hire extra staff to properly and effectively implement the project?)
(11) Jordanian national policies/ Royal initiatives that align with the project *Attach supporting URLs of the policy, initiative	Name of the policy/ initiative	Issued year	Explanation and URL*Max 5 lines.
(12) Other existing organizations working in the same field with the proposed project	Name of the organization	Services provided *Max 3 lines.
(Public)
(Private)
(UN / NGO)
Please explain how your project is distinct from those described above.
(13) Blueprint of the project site/building/room after procurement *Please refer to the sample picture and replace it with your own.	[Example]
(14) Photos of current site *Please take photos of the site(e.g. entrance of the building, rooms, etc.) and add caption for each photo.

APPLICANT DETAILS
(1) Name of the organization	English
Arabic
(2) URL of the website of the organization
(3) Year of registration
(4) Registered authority
(5) Nature of the organization	Select
(6) Main activities of the organization *Describe in less than 4 lines
(7) Address of the HQ office *Add your street, city, municipality and Governorate
Google map URL of the location:
(8) Representative of the organization *the person with authorization to sign a Grant Contract	Title:
Name:
Phone number:	Email:
(9) Focal point of the organization *the person responsible for this project	Title:
Name:
Phone number:	Email:
(10) Number of staff	Board members: Paid staff: Unpaid volunteers:
(11) Organizational structure	Job Title / Department	Number of Personnel
1
2
3
4
5
6
TOTAL
(12) Financial assistance received from foreign governments, INGOs *Newest to oldest	Period	Donor	Project title (amount)	Reference *press release, web page, SNS post
Apr 2017 ~ Mar 2018	Embassy of Japan	The Project for XXXXXXXX (YYY,YYY JOD)
(13) Financial assistance received from Jordanian Government *Newest to oldest
(14) Summary of financial report	Income (JOD)	Expenditure (JOD)	Balance (JOD)
FY2023
FY2024
FY2025
(15) Previous GGP projects	☐ Yes (If yes, specify below) ☐ No
Signed year	Project title

Application Pledge

To the best of my knowledge, the information provided in this application contains only the truth.

I agree, on behalf of the applying organization, if the Government of Japan approves the grant for abovementioned project, we shall pledge that;

The Organization has the legal right to apply for the grant. The organization shall promptly begin necessary procedures with the relevant authorities of the Government of Jordan upon request of the Embassy to receive the grant from the Government of Japan.

We shall be fully responsible to prepare suitable space for the provisions, maintain the provisions, and use them properly and exclusively for the project for at least five years in Jordan.

We shall bear any taxes including sales tax and custom if it’s charged to any project related items.

All necessary expenses for the use and maintenance of all purchased items by the grant, in addition to the operational and administrative cost shall be the responsibility of the organization.

In case that the grant amount is insufficient to complete the project for any reason, the organization shall be responsible for bearing the shortage cost and complete the project.

We shall not make any changes to the content of approved project such as purchase of the items other than the agreed ones, or reallocation of the grant budget and of the purchased items without obtaining a prior approval from the Embassy of Japan.

We will continue to maintain the level of services provided with the current staff members. In addition, we will employ additional staff necessary to implement the project successfully.

We shall open a bank account dedicated only for the project. Commission fees and transaction fees for the bank shall be covered by the organization.

Before withdrawing any amount of the transferred fund from the bank, we shall inform the Embassy of Japan in writing the amount and the purpose enclosing the latest quote from supplier in order to acquire its permission.

We shall make a donor plaque with the Japanese flag, in order to express our appreciation.

We shall appoint an external auditor to conduct an audit for the grant extended by the Government of Japan.

The Organization shall not make any changes to the content of the approved Project such as purchase of additional items other than the agreed one, reallocation of the grant budget or relocation of the Project’s equipment without prior written approvals from the Embassy of Japan.

The Organization shall accept follow-up visits by the Embassy 2 years and 4 years after the completion of the Project.

Name:

Title: (representative)

Signature:

Date:

Attach the following checklist with your application.

Applicant checklist
I have read the guideline in detail before submitting my application.	☐
I have read the commitment clauses on the last page of this application (Application Pledge), and it has been signed by the representative.	☐
My organization has been registered and has been operating for at least 2 years.	☐
Necessary Attachments
Application Form 1 (in English)	☐
Application Form 2 (in English)	☐
Financial reports for the past 2 years (preferably in English)	☐
Quotations for each item from 3 suppliers	☐
Copy of registration certificate of the organization	☐
Only for Constriction/ Renovation project Copy of the ownership certificate or long term contract of land and/or building	☐