Emergency grant for human rights defenders at risk-ProtectDefenders

Grant application form

Please answer the following questions

1a) CONTACT DETAILS OF THE APPLICANT
Full name*
Gender*
Name of the organisation (if any)
Country of origin **
Country of residence **
Preferred contact method
Phone number
E-mail address **
1b) CONTACT DETAILS OF THE HUMAN RIGHTS DEFENDER (IF DIFFERENT FROM THE APPLICANT)
Full name
Gender*
Name of the organisation (if any)
Country of origin
Country of residence
preferred contact method
Phone number
E-mail address
2. AREA OF WORK
Please insert a description (250 – 4000 characters) of your work as Human Rights Defender (area of work and what your work consists of). If you are a member of an organisation, please also describe the organisation's mission and main focus of work.
Area work
3. SECURITY AND RISKS
Please describe (250-8000 characters) the event that has prompted your application. When did this event occur? What security risks are you facing and why? Please include information about the type of threats, authors of the threats, and possible evidence (e.g., links, references). Any files containing evidence can be attached to the e-mail sent to us. Please insert a short description for each piece of evidence.
SECURITY AND RISKS
4. PROPOSED ACTIVITIES
Please describe (250 – 4000 characters) how would you use the grant and what are the proposed actions to address your situation. What activities do you want to do, what measures will you put in place? How would this grant reduce the risks faced? What are the expected results and impact of these measures?
PROPOSED ACTIVITIES
5. SIMILAR APPLICATIONS SUBMITTED
Did you make similar applications to other possible donors?
If yes, please specify who (please provide contact details)
No/Yes*
Name(s) of the organisation(s)*
Name(s) & Contact Details of Contact Person(s)*
DID YOU MAKE SIMILAR APPLICATIONS TO OTHER POSSIBLE DONORS ?
Have you received any grant from other organisation for similar purposes in the last two years?
If so, specify who, amount and costs covered.
No/Yes*
Name(s) of the organisation(s)*
When did you receive the grant?*
What was the grant allocated for?*
Amount of money received for this grant*
Hidden
HAVE YOU RECEIVED ANY GRANT FROM OTHER ORGANISATION ?
6. BUDGET
Please provide a budget with a breakdown of costs and an explanation on how costs have been defined. Please note that the maximum budget is 10.000EUR, and the average allocated grant is of 3.000EUR.
Please indicate the currency which you will use when filling out the budget form.
Currency*
Total requested amount*

Budget

ITEM/COMPONENT	UNIT VALUE	NUMBER OF UNITS / MONTHS	TOTAL	DESCRIPTION

7. REFERENCES
Please provide contact details (name, organisation, phone, email, Skype account, etc.) for at least two references who are well known within the human rights community in your country or internationally and who know your human rights work and the risks and threats that you face as a result of your activities. Please note that the references should preferably not be working at the same organisation as the Applicant/Human Rights Defender.
REFERENCE 1
Name*
Organisation*
Contact Details*
REFERENCE 2
Name*
Organisation*
Contact Details*
8. HOW DID YOU HEAR ABOUT PROTECTDEFENDERS.EU?
HOW DID YOU HEAR ABOUT PROTECTDEFENDERS.EU
9. CONFIDENTIALITY
Should any specific information about the request be kept confidential? If so, ProtectDefenders.eu will not disclose individual names and contact information to any party outside of the organisation.
CONFIDENTIALITY
This form is encrypted and its content is not shared with third parties. ProtectDefenders.eu will use your data exclusively to process your grant request.
Consent*
I confirm I have read, understood, and agreed to the ProtectDefenders.eu privacy and data protection policy**
Consent*
I accept the processing of my data for the purposes of this request, in accordance with the privacy and data protection policy of ProtectDefenders.eu**
Phone
This field is for validation purposes and should be left unchanged.

NOTE: If the request is considered eligible, the applicant will be put in contact with NGOs members of the ProtectDefenders.eu consortium, who may reserve the right to ask additional questions. Being put in contact with an NGO does not mean that the grant will be automatically allocated: the NGO will still have to review the application.

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