Submission Date:

General Information

A. Organization

Organization Name:
U.S. Tax Status (Refer to Tax Status Definitions ):

Institutional Official authorized to submit and accept grants on behalf of organization:

Prefix		First name		Surname		Suffix
Title		Telephone
Address
E-mail
Web site

B. Project

Project Name:

Principal Investigator/Project Director:

Prefix		First name		Surname		Suffix
Title		Telephone
Address		Fax
E-mail
Web site

Amount Requested From Foundation, (not to exceed $3M USD):	$	Project Duration (months):
Estimated Total Cost of Project ($USD):	$
Organization’s total revenue for most recent audited financial year ($USD):	$

C. Geographic Location(s) of Work and Area(s) to be Served

Geographic Location(s) of Work refers to all locations (country, and region/state if known) in which work will be performed with funds from this grant. This includes locations in which sub-grantees or sub-contractors will work. In the table below please provide the location and the approximate amount estimated to be spent in each location. For example: A $1,000,000 grant may reflect $600,000 to be spent in the United States and $400,000 to be spent in South Africa. If you propose to have staff working across multiple locations, costs may be allocated to the location where they will spend the majority of time. Please reflect the total requested grant amount.

Geographic Location(s) of Work
Country and Region/State	Amount
	$
	$
Total Grant Request	$

Geographic Areas to be Served refers to all countries intended to benefit from this grant. This is where the target population is located, not necessarily where the work is occurring. For India, include the names of states. “World” is an acceptable response if there will be broad public benefit. In the table above, please provide the location and the approximate amount estimated to be spent in each location. Please reflect the total requested grant amount.

Geographic Area(s) to be Served
Country/Continent	Amount
	$
	$
Total Grant Request	$

D. Regulated Research, Lobbying and Global Access

Regulated Research: The following questions are intended to identify proposals that involve humans, animals, or sensitive regulated research. Please consult with your assigned program officer if there are any questions regarding how these questions should be answered. Note that the Gates Foundation reserves the right to request copies of any documents that pertain to regulated research supported by our funds.

Will the project involve research using human subjects ?	YES FORMCHECKBOX NO FORMCHECKBOX
Will the project involve research using vertebrate animals?	YES FORMCHECKBOX NO FORMCHECKBOX
Will the project involve the use of recombinant DNA?	YES FORMCHECKBOX NO FORMCHECKBOX
Will the project involve the use of biohazards?	YES FORMCHECKBOX NO FORMCHECKBOX
Will the project involve the use of genetically modified organisms or plants?	YES FORMCHECKBOX NO FORMCHECKBOX
Will the project involve the use of pathogens/toxins identified as select agents by U.S. law?	YES FORMCHECKBOX NO FORMCHECKBOX

Restrictions on Lobbying Activities: The Foundation is prohibited from conducting or funding any lobbying or political campaign activities, as these terms are specifically defined under U.S. tax law. Unlike many of our grantees who may engage in limited lobbying, the Foundation cannot lobby or fund any lobbying activities carried out by its grantees. We request that you please review the information at the following link, Foundation Funds and Advocacy , to assess whether any of your proposed activities may constitute lobbying as defined by the IRS.  If so, you should revise your proposal accordingly prior to submission.

Will this project include lobbying activities?

YES FORMCHECKBOX NO FORMCHECKBOX

Global Access Committment . To ensure that any results of your project are made available and accessible to those that would benefit, if your proposal is approved, the following clauses will be required in the grant agreement:

Global Access .  You will conduct and manage the project and the resulting products, services, processes, technologies, materials, software, data or other innovations (collectively, “Funded Developments”) in a manner that ensures “Global Access.”  Global Access requires that (a) the knowledge and information gained from the project be promptly and broadly disseminated and (b) the Funded Developments be made available and accessible at an affordable price (i)  to people most in need within developing countries or (ii) in support of the U.S. educational system and public libraries, as applicable to your proposed project.  The Foundation is making this grant in reliance on the descriptions and answers provided to the Foundation in your proposal.  Your global access obligations will survive the grant period.

Limited License to Foundation. You grant the Foundation a perpetual, irrevocable, nonexclusive, worldwide, royalty-free, fully paid up, and further sub-licensable license to use Project IP to use, conduct research, develop, modify, make, have made, offer for sale, sell,import, reproduce, publicly perform and display, distribute and make derivative works of products or processes that are for or related to the diagnosis, treatment, prevention or monitoring of Target Diseases and Conditions, provided such products or processes are intended for sale to or use in the Territory consistent with the Foundation’s charitable purposes.. The principal purpose of the license granted to the Foundation is to ensure that Global Access is achieved. During the implementation of the Project, you may demonstrate to the satisfaction of the Foundation that Global Access can best be achieved without such a license (or a license of different scope). In such a case, the Foundation and you agree to make good faith efforts to modify or terminate this license, as appropriate. Any such modification or termination will be at the discretion and approval of the Foundation.

“Target Diseases and Conditions” means polio, malaria (including falciparum and vivax), insecticides and other vector tools as applied to prevention for any human vector borne disease (including malaria, lymphatic filariasis, dengue, onchocerciasis etc.), tuberculosis, HIV, herpes simplex virus (including syphilis and gonorrhea), rotavirus, cryptococcus, typhoid, paratyphoid, cholera, neglected infectious diseases (including hookworm, trichuria, ascariasis, macrofilaricide, loa loa, leishmaniasis, trypanosomiasis, human papilloma virus, chagas, rabies, cysticercosis, trachoma, onchocerciasis, schistosomiasis, Japanese encephalitis, dengue), pneumonia (including RSV, influenza, pneumococcus, Hib, and paraflu), diarrhea/enteric diseases (including ETEC, shigella, crypto, cholera, typhoid, rotavirus; malnutrition and anemia as two target conditions, hepatitis B, hepatitis C, zinc, ORS); and further includes contraception and conditions that threaten maternal, fetal, and child health (e.g., preterm birth, neonatal sepsis, birth asphyxia, maternal hemorrhage, preeclampsia, maternal sepsis, and obstructed and prolonged labor).

“Territory” means the 57 countries that are currently eligible for support from GAVI and identified at http://www.gavialliance.org/support/apply/countries-eligible-for-support/ and Thailand and South Africa.

“Project IP” means rights you hold in intellectual property (or applications therefore), whether registered or not, granted in any jurisdiction, including (but not limited to) copyright and related rights, database rights, patents, and trade secrets or confidential information that arise during work performed as part of this Grant. This includes work done in the current phase of the Grant and in earlier phases of this or a related grant by the Foundation.

Project Narrative

The narrative must be no longer than 3 pages, using no smaller than 10 point font. Page limit excludes the General Information section above, the appendices and the budget narrative. Proposals that do not adhere to these restrictions may be delayed in the review process or declined. If you choose to include charts, graphs, or references, add them within the appropriate section. A Glossary of Terms is provided for your reference.

Section I. Project Description

Briefly describe your proposed project. Make sure that your idea aligns with the relevant Global Program strategy.

· Indicate in one or two sentences the essence of your project.

· Describe your vision of success and the most significant result(s) you hope to achieve.

Section II. Project Implementation

Briefly describe the project design and implementation plan.

· Describe your project, including the objectives and key milestones associated with each objective.

· What outputs or outcomes will be achieved through the stated activities?

· If the outcomes or outputs are achieved, what would be the next steps?

· How will the work you describe be performed within the budget requested?

· Indicate whether or not there are additional cash or in-kind funding sources for this project.

Appendix A: Milestone and Budget Templates

Use the templates provided to list the project milestones by objective and to submit the budget for the project. Instructions for completing the spreadsheets are included in the templates.

Budget Narrative

The purpose of the budget narrative is to supplement the information provided in the budget spreadsheet by justifying how the budget cost elements are necessary to accomplish the project. Together, the budget narrative and budget spreadsheet should provide a complete financial and qualitative description that supports the proposed project plan.

A. Personnel and Fringe Benefits (Direct FTE Costs)

Personnel : Provide the name and project role of every person listed on the budget. Also please identify key personnel on the project.

Fringe: Describe the components in the fringe benefits package provided to personnel. Examples of components are health and dental insurance, life insurance or pension contributions.

B. Direct Travel

Provide the number and type of trips and total cost of the travel request. If there are unusual or special circumstances that require a high volume of travel, please provide an explanation that justifies the expense.

C. Direct Consulting

Describe the work to be performed by any consultants and how the work is necessary to accomplish the results of the project. Describe the cost components of consultants’ expenses (including travel, supplies and other costs, for example).

D. Direct Supplies and Equipment

Provide a brief description of the requested supplies, services or other costs (e.g. maintenance contracts, publication costs) and explain how the items will be used to accomplish the work on the project. Provide a brief description for each item of equipment requested.

E. Sub-grants and subcontracts (Sub-awards)

Describe the attributes and expertise of each organization chosen to participate on this project as a sub-grantee or subcontractor and to which specific objective their participation will contribute.

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Preface

The Bill & Melinda Gates Foundation believes that every person should have the opportunity to live a healthy, productive life. In the Global Health Program, we work to ensure that lifesaving advances are created and shared with those who need them most. We consider proposals that address diseases and conditions that cause a high burden of disease in the developing world.

We appreciate your organization’s interest in submitting a proposal to the foundation and suggest that you read through this entire document before beginning your proposal. For more information about the foundation’s grantmaking processes please refer to the following link: Our Approach to Grants

Proposal Evaluation & Review

The foundation evaluates proposals according to the principles listed below. While these principles form the basis for foundation thought, not all principles are applicable to all projects. In some cases certain principles may not be appropriate due to the nature of the project or the type of activities needed to reach the goal.

Catalytic: Will our investment allow key barriers to be overcome so that others can continue the work of addressing the health issue and advancing the field?

Innovative: Will the project test new ideas, approaches, technologies, or tools? Will it use novel approaches to solve problems, and develop models that allow for replication and scaling-up?

Evidence-based: Does the project apply credible data, information, and knowledge to solve the greatest problems in global health? Will the project create, build, and apply this knowledge base to reduce suffering in the neediest populations?

Intellectual Rigor: Will the project take advantage of the best learning in the field? Is there a clear case for why this is the best approach? Is the proposed approach likely to yield the described result? Is this an efficient use of resources?

Sustainable: Will the project create solutions that can be continued after the grant is finished?

Significant: Will the project result in changes that will advance the field and benefit those most in need?

Collaborative: Will the project bring together organizations and institutions and take advantage of their experience and expertise?

Learning: Will the project contribute to specific outcome and impact goals set by the foundation, measure results, and respond to what is working and what isn’t?

Equity: Does the project address the needs of the world’s poorest people, those earning less than $2 per day, who suffer disproportionately from disease?

In addition to the principles outlined above, the following information is also critical to the evaluation of the project:

Project Framework

The foundation will review the overall goal of the project and how it contributes to a specific strategy (e.g. Maternal and Neonatal Child Health). The project goal should have clear, specific, and measurable objectives that can be accomplished through a defined set of activities. Intended results should be identified to assess progress against the goal and objectives along with a measurement plan to show how results will be measured. Assumptions that are inherent in the project plan will also need to be identified so that the foundation can understand the factors outside of the direct control of the project that may affect its success, and how the grantee will mitigate any risks.

Organization and Leadership Q