CSI

Application Form



Name of Organisation/ Institution

Type of Organisation/ Institution

Reg. No.

Date Registered



CONTACT DETAILS:
Contact Person

Position

Contact No. Work

Cell

Email Address

Website

Physical Address (Max 400 characters)

Postal Address (Max 400 characters)

Primary Focus



ORGANISATION STRUCTURE
Brief Overview of Organisation (Max 400 characters)



STAFF CURRENTLY EMPLOYED:
(Insert Number)
Racial Profile
African

White

Coloured

Indian

Gender
Female

Male

Disabled



EMPLOYED OVER TWO PROCEEDING YEAR:

Racial Profile
African

White

Coloured

Indian

Gender

Female

Male

Disabled



VOLUNTEERS: (If Applicable)
Racial Profile

African

White

Coloured

Indian

Gender
Female

Male

Disabled

Nature of Request

Describe Project (Max 400 characters)

Desired Impact of Funding/Project Objectives (Max 400 characters)

How is it measured? (Max 400 characters)

Project Sustainability
(How will the project sustain itself/Will it always be dependent on funding?) (Max 400 characters)



BENEFICIARIES :
(Insert Numbers)

Racial Profile

African

White

Coloured

Indian

Other

Gender

Female

Male

Disabled

Project Budget (Provide Comprehensive Breakdown)



Other Donors

Name

Amount Secured

Date Funding Lapses


Additional Attachments:
Latest Financials

Latest Annual Report

Registration Documents

Quotations/Supporting Documents for Funding



List of Director's and IDs
1. Name

ID

2. Name

ID

3. Name

ID

Additional Director
4. Name

ID

CSI Form