Title

Please provide a title for your activity that clearly identifies its objective:

Applicant details

Are you an organisation or business group legally registered in Laos?

Yes / No

Enter the name of your organisation or business group:

Are you partnering with an organisation or business group legally registered in Laos for this activity?

Yes / No

If you answered yes to the question above, please enter the name of the organisation or business group you are partnering with in Laos:

Please tell us how the activity will be managed:

If the activity will be delivered in partnership with another organisation, who will lead and what will each partner’s role be?

Description

Please describe the activity and include a description of who will benefit and how:

The description should identify the objectives and beneficiaries of the activity not just deliverables (for example, don’t just list events that will be held, or items that will be purchased).

Proposed start date

Please tell us when the activity will begin:

Proposed end date

Please tell us when the activity will end:

This should include time for preparing a report once the activity is complete

Funding

Please complete the table below:

Please list what the grant monies be spent on:

Funding (continued)

Please list what funding from other sources will be spent on, or what in-kind support will be provided by others:

This could include peoples time spent managing the activity, materials or land provided for free, etc.

Risk

Will the activity involve contact with children or working with children?

(If yes, complete the separate child protection assessment below)

Yes / No

Will the activity involve building or construction?

(If yes, in your activity description above please explain (a) how you will ensure local waste management rules and regulations will be followed, and (b) whether or not the activity will involve exposure to asbestos.

Yes / No

Do you and/or your implementing partner (if applicable) have experience in managing this type of activity?

(If no, please explain how you will identify and manage risks during activity implementation)

Yes / No

Please explain the risks that could occur during this activity and how will they be mitigated:

Gender Equality, Disability and Social Inclusion

Will the activity provide equal access to resources and/or opportunities to beneficiaries regardless of their gender or ethnicity?

Yes / No

Will people with a disability be able to benefit from the activity as equally as people that do not have a disability?

Yes / Nov

If you answered yes to either of the questions above, please describe here how the activity meets this criteria:

Community Support

Please explain how this activity has the support of the community that will benefit:

For example, this can be demonstrated by the contribution of funding, materials or labour for the activity, or through demonstrating that the community is seeking this assistance.

1. Contact with Children - Assessment

Will personnel be deployed outside their usual place of residence (e.g. will the activity involve travelling to a remote community, or working away from the organisation’s office)?

Yes / No

Will personnel be alone with children during the activity?

Yes / No

Will the activity Involve direct one-on-one or group access to children online, supervising child-to-child online contact, or access to a child’s or children’s personal and/or confidential information?

Yes / No

1. Working with Children - Assessment

Will the activity engage with children who are vulnerable?

(e.g. children whose true or cognitive age impacts on their ability to protect themselves, who have challenges (psychological, situational) that contribute to their vulnerability, children who do not have many support systems)

Yes / No

Will the activity involve unsupervised contact with children?

Yes / No

Will the activity involve the need for physical contact/touching children?

(e.g. assisting children with washing, dressing, toileting)

Yes / No

Will the activity include a monopoly on provision of goods and/or services

(e.g. will it provide the only source of medical treatment, food, training opportunities)

Yes / No

Will the activity involves developing close, personal, long term relationships with children?

Yes / No

Will the activity involve transporting children without their family/caregiver?

Yes / No

Will the activity lead to the employment of children or in children not attending school?

Yes / No

Will the activity engage children whose parents are vulnerable?

(e.g. parents who do not have many support systems or whose circumstances (poverty, disability) impact their ability to protect their children)

Yes / No

1. Further information

If you answer yes to any of the questions above, please provide detail below. For example, if personnel will be alone with children, please explain where this will happen and why this is necessary.