Request Form

to obtain resources and funding from the International Harm Reduction Consortium

The data provided in the form will be stored in a secure database. Commission members will sign a non-disclosure form.

Organization / Group

Name, Surname position in the organization/group of the authorized representative submitting the grant proposal

Country

Describe what specific issues you address as a group/organization and share with us the results of your activities for the period of 2017-2018 (including protests and voluntary work. Please, provide the links to your media. No more than 300 words)

Location

Contact person on resource assistance (Full Name, e-mail)

Please, choose one of EHRA's four priorities according to the Position on Drug Policy that corresponds to the topic of your application. Due to limited resources, please submit one application for one topic.

☐Abolition of criminal and/or administrative penalties for drug use, possession and purchase of drugs for personal use

☐Advocacy actions aimed at ensuring that mental and behavioral disorders due to drug use should no longer be an aggravation but should be considered as a basis for social and medical care provision.

☐Advocacy for the introduction of alternatives to punishment for drug-related crimes;

☐A cost analysis of repressive drug policy, redistribution of funds currently allocated by the state for special security operations and prison detention to support harm reduction programs and other health and social care practices.

Describe the situation, your actions and objectives that require funding. We will prioritize the provision of resource assistance according to the information you provide.

background: analysis of the situation that you would like to change (300 words). Our experts will focus on the availability of data showing that the group/organization is aware of the situation and has testimonies and evidence confirming the problem.

Evaluation criteria: the group/organization has already collected evidence and data to build the evidence base of the problem – up to 10 points

The activities plan to solve the problem, including the description of the activities implemented at the time of the request and the results. The experts will focus on the activities that have already been implemented and what you have managed to achieve. So, please, send us all the links and information about the activities you have already tried to implement or successfully implemented according to the topic of your request.

Evaluation criteria: 2. The group/organization has formulated its objective for 2019, provided the activities plan and documented its previous actions to solve the problem – up to 10 points.

Task: What, where, when, why	Action plan (you may describe plan A, plan B and plan C)
What result will satisfy the community	Which of the public services is responsible for this objective and how it currently responds to your actions.	What actions should be performed
What has the group/organization already done	What is planned to be done using a small grant	Who is responsible for the result in the group/organization

How are you going to invest the grant funding to achieve your goal. Prepare the budget for your project using the form below. The funding ceiling: 4,375 USD per grant. Please describe what part of the activities will be covered by the grant and distribute the funding according to the objectives: plan the expenses for reimbursement and remuneration, funding for the events, etc. Up to 10 points.

Specify the project implementation period (June - November 2019, from 3 to 6 months)

Expenditure type	Units of measure	Number of units	Unit cost, USD	Amount, USD	Comments
Salary/payment for employees/consultants	Per month or per hour
Travel/meeting costs
Other types of expenses (please specify)
Administrative costs (banking fees, office, etc.)

Describe what result do you expect to achieve with your actions, what products/events will be created using the requested resource assistance (150 words): the evaluation criteria here is: the group / organization understands what results it is going to achieve and what actions are necessary to take to do this - up to 10 points.

Please check the following options for providing support that you expect to receive from us as a resource assistance in addition to the small grant. Please check the options if you already know the detailed information on: topics, countries for internship, what skills are needed and/or what organizations or experts you want to establish contacts with. The more specific your application is, the more effective our partnership will be.

☐Raising awareness of international drug policy trends, translation and clarification of reports and recommendations

☐Development of tools for advocacy and community monitoring

☐Training and webinars to enhance the expert capacity of civil society

☐Internships to share best practices

☐Support the development of community organizations, assistance in developing the procedures, policies and management systems

☐Individual mentoring/coaching support to community leaders in advocacy

☐Research to gather evidence in countries

☐Presentation of country cases at international advocacy platforms

☐Regional advocacy campaigns to support the community in various countries

☐Establishing direct communication between the community and decision makers, international experts, donors and UN agencies.

Your proposals

Special provisions for obtaining resource assistance. Your testimonies and facts will allow us to prepare and implement joint activities in a better way and ensure the highest level of safety and effectiveness for the reputation, position and achievements of the organization/group seeking our support.

- please specify whether you are able to exercise the right to freedom of expression without being persecuted by the government or other policymakers;

Testimonies (happened to me or to other people in my inner circle), facts and links to sources

- The legal and political situation allows the community/civil society networks to operate, including your right to register and work as non-profit/non-governmental organizations without discrimination.

Testimonies (happened to me or to other people in my inner circle), facts and links to sources

- special conditions for obtaining resource assistance (300 words): Please specify whether you are able to receive financial support by transferring the funds to the bank account of the organization, or whether there are restrictions according to local policy. If yes, please describe the situation and possible solutions.

Testimonies (happened to me or to other people in my inner circle), facts and links to sources

The link to the website of the organization /group

The links to social media pages of the organization /group