JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Democratic Governance | Zambia
Please use this form to submit your expression of interest. Any submissions not done via this form will not be considered. You will receive an email with a copy of your proposal after your submission. If you do not receive a confirmation email, please contact us by email (info@civictechfund.africa). If you would like to prepare the proposal in a word document before submitting it through the present form, you are welcome to download and use the file available here:
https://docs.google.com/document/d/1Yi_gwsIbVdLyzjlqRnzsi9G_zhD1LMups_piLIWj-vw/edit?usp=sharing
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
About the organisation
Name of organisation
*
Your answer
Type of organisation
*
Registered not-for profit organisation
Registered company
Other:
Address
*
Your answer
Registration location
*
In which city is the organisation registered?
Your answer
Registration number (if available)
Your answer
Website (if available)
Your answer
About the contact person
Name of contact person
*
Your answer
Position of contact person in organisation
*
Your answer
Phone number of contact person
*
Your answer
E-mail address of contact person
*
Your answer
About the proposal
Call for proposals
*
Please confirm that you are submitting a proposal for the Call “Democratic Governance in Zambia”.
Yes
No
Pitch
*
Please specify the problem you would like to solve, your target groups and describe the civic tech solution you would like to propose. Please describe how this relates to a priority or several priorities stated in the guidelines. 1980 characters (with spaces) or less.
Your answer
Contextual factors
*
Please mention the contextual factors that need to be taken into consideration. 660 characters (with spaces) or less.
Your answer
Scope
*
Are you proposing to upscale, adapt or replicate an existing civic tech solution or are you seeking to develop a solution from the ground up? 660 characters (with spaces) or less.
Your answer
Goals and/or expected outcomes
*
Please describe which goals and/or expected outcomes you would like to contribute to through your initiative. 660 characters (with spaces) or less.
Your answer
Risks and assumptions
*
Describe the risks and underlying assumptions associated with this project. 660 characters (with spaces) or less.
Your answer
Relevant experience
*
Please indicate any previous or on-going experiences that are relevant to your proposal. 660 characters (with spaces) or less.
Your answer
Indicative budget amount
*
Please indicate the financial support you apply for (within the grant ceilings specified in the call’s guidelines).
Your answer
Proposed start date
*
MM
/
DD
/
YYYY
Proposed end date
*
MM
/
DD
/
YYYY
Website links
If you would like to share any hyperlinks where we can learn more about your previous or current work and approaches (particularly if your request relates to the adaptation or upscaling of an existing initiative.
Your answer
Any other comments
Please feel free to add any other comments you may have. 660 characters (with spaces) or less.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of European Partnership for Democracy.
Report Abuse
Forms
