THE UNITED STATES AFRICAN DEVELOPMENT

FOUNDATION
STANBIC KENYA FOUNDATION
2022

ENTREPRENEUR’S NAME:

PROJECT NAME:

ENTERPRISE NAME:

COUNTRY OF RESIDENCE AND NATIONALITY:

YES NO IF YES
1 Is the entity 100% African owned and managed? Attach an authenticated
document of ownership
2 Is the entity legally registered in Kenya Attach certified copy of
registration certificate
3 Does the entity have management or audited accounts Attach copies of the
for the last 2 years? management or audited accounts
for the last 2 years
4 Has the entity operated bank accounts for the last 12 Attach copies of bank statements
months? for the period Jan 21 to Jan 22
5 Has the entity applied for and denied a commercial loan Attach a statement providing the
name of the financial institution
and reasons for the loan request
decline

2022 Call for Application Form Page 1 Jan 2022.

 USADF GRANT APPLICATION
6 Is the entity owned by majority youth and/or women Attach list of owners with age
and gender details

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 USADF GRANT APPLICATION
(Note: Applicant to fill blank boxes, USADF Staff will update shaded areas (NA) after the site visit).

Country: Name of
Project:
Estimate of Local Currency: Investment Type:
Funding Request: U.S. $ equivalent: NA NA
Length of Project Exchange Rate: NA
(months)
Legal Name of Applicant:
Other Names Applicant is known
by or does business as:
Legal Status Type of Applicant:
*For Enterprise: # of Full Time Male NA Female NA Total NA
Employees
*For Enterprise: # of Part -Time Male NA Female NA Total NA
Employees
*For Enterprise: # of Male NA Female NA Total NA
Suppliers/Farmers or Enterprises
Supplying Raw Materials
**For Enterprise: # of Customers Male NA Female NA Total NA
/Beneficiaries Purchasing a good
or service
Applicant Contact Points:
Name of Primary
Contact:
Position:
Telephone:
E-Mail:
Location of the Organization/Business:
Physical Address:
Mailing Address:
City or town [if urban]:
Village [if rural]:
Nearest Town [if rural]:
Event: App. Grant Date
Rcvd.
Date NA NA
SIGN-OFF
I understand that a material misstatement or the omission of material facts may stop the United States African Development Foundation
from providing funding, may require the termination of any funding that is awarded, and may give cause for legal action by the Foundation.
I confirm that I have necessary authority to act for and on behalf of the company in making the foregoing statements and that they are
correct, to the best of my knowledge and belief, and that no statements of fact are omitted from this questionnaire which are necessary in
order to make the statements herein not misleading.
Applicant

* Suppliers/Farmers/Enterprises currently impacted over the past two years

• Members OR non-members of a cooperative that receive trainings from the applicant enterprise / cooperative
• Members OR non-members gaining access to revolving loan or input funds planned in the proposed project
• Full time or part time employees funded through activities related to the proposed project
*Please be sure NOT to double count beneficiaries who will receive multiple benefits from the proposed project.
** Based on applicant’s sales records, the number of customers who purchased goods/services directly from the applicant

USADF/Stanbic Program _ Application Form January 2022

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 USADF GRANT APPLICATION
NOTE TO APPLICANT: The Project Funding Application includes four sections below:

A. Organization Information
B. Current Financial Situation
C. Project Proposal Information
D. Project Budget
E. Supporting Documents

Please follow this outline in developing your application request. The answers to the questions below should
be brief and to the point not exceed 10 pages. If your application is accepted, additional details will be
required.

APPLYING FOR AN USADF GRANT IS FREE, THERE IS NO FEE ASSOCIATED

WITH A GRANT APPLICATION.

A. ORGANIZATION INFORMATION

1) The organization was established in ________ (year)

Date of Legal Registration (Month / Day / Year) __mm__ /_day__ / _Year_

2) Please state the mission or purpose of your organization or enterprise. Limit response to one paragraph.

3) Provide a short description of the most significant achievements your organization has made in the past
three years. Limit response to 1 page or less. Include total annual operating income for each year.

Year Achievement Annual Income

2021
2020
2019
2018

4) Provide a short description of how the organization or enterprise generates its revenues. Limit response to
one paragraph.

5) What is the primary commodity(ies) or product(s) that the organization or enterprise produces for
revenues? Limit response to one paragraph.

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 USADF GRANT APPLICATION

6) If applicable, describe the Ownership Structure:

List of current Owners

Name Gender If youth Citizenship %
give age Ownership

7) If applicable, describe the Governing Structure:

List of Board Members

Name Gender If youth Citizenship
give age

8) If applicable, describe the Management Structure:

List of Executive Committee members and top Managers and Senior Staff
Name Qualifications Years with Organization

9) Indicate the current number of Employees:

Total Full Time: ______ Men_____ Women_____

Total Part-Time/Seasonal: ______ Men_____ Women_____

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 USADF GRANT APPLICATION

B. CURRENT FINANCIAL SITUATION

1) List any loans (amounts, term, provider), and other liabilities attached to the organization?

Loan/Liability Type/Term/Provider Value Balance Due

Other:

2) A) List all sources, amounts, and dates of any donor, government or other outside funding received.

Donor Name Date Type (Loan / Grant) Value

B) Have you requested any other funding (grants or loans) support from other donors, NGOs, government,
private companies, or banks that are still being considered? If yes, please list details below.

Donor Name Date Type (Loan / Grant) Value

C) Reasons for loan/grant approval delay: Provide details of why the loan(s)/grants is/are not yet
approved and any conditions given to the enterprise for the loan(s)/grants approval to be made.

D) Have you applied for a loan from a financial institution and the request denied? Yes/No

If yes, please list details below

Financial Institution Date when the request was made Amount of loan requested
1.
2.
3.

What reasons did the financial institution give for declining the loan request? ________________________
______________________________________________________________________________________

3) Identify future funding opportunities.

A) Did you apply for Stanbic funding: Y/N?

If yes, please provide 1) the loan amount(s) applied for and (if not yet approved), 2) details on why the
loan(s) is not yet approved and any conditions given to the enterprise for the loan(s) approval to be made.

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 USADF GRANT APPLICATION
B) List the name(s) of credible* potential financing organizations, other than Stanbic, you have identified.
(*Credible potential financing means: The group has contacted the source of follow-on financing and
understands the requirements to obtain financing from this source.)

Financer Name Type (Loan / Grant) Value

4) Does the organization or enterprise have a trained accountant or bookkeeper? Yes / No

If yes, what is his/her qualifications?

5) (i) Does the organization or enterprise have two years of financial statements? Yes / No

(ii) Are the statements audited? Yes / No

(iii) If yes, attach copies of the most recent audited accounts together with copies of management
letters and if not audited, attach copies of the management accounts for the same period.

6) (i) Does the organization or enterprise operate a bank account for business transactions? Yes/No
(ii) If yes provide name and branch of the bank and the period this account has been operated

Bank name Branch When the account was opened

C. PROJECT PROPOSAL INFORMATION

1) What specific constraint(s) is/are preventing the enterprise from accessing commercial investment?

2) How will this grant allow your organization or enterprise to address the constraint(s) identified in (1)
above?

3) List the primary activities that must be completed to make the enterprise investment ready.

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 USADF GRANT APPLICATION
4) What is the biggest risk facing your organization or enterprise and the success of this project? Limit
response to one paragraph.

5) If this project is successful and the enterprise qualifies for follow-on investment to address productive
activities:

i) What quantifiable results will the project achieve with the follow-on investment for the target
customers, suppliers, and/or other beneficiaries? What will the development impact be? How will
you measure success? Provide at least two tangible measures that you can measure.

Examples:
 XYZ agribusiness will utilize new food processing and packaging equipment to increase
production by 25%, from 40 tons of product to 50 tons.
 300 plantain farmers in northern Ghana will increase their incomes by 33%, from $2.50 a day to
$3.75, by selling 50% of their crops to the applicant’s agribusiness company.
 300 farmers will be trained on best practices for irrigation, composting, and mulching, to reduce
their cost of commercial fertilizers by 20%.

(ii) How will Sales Revenues increase over the next four years with the follow-on investment?

Baseline Annual Sales Year 1 Year 2 Year 3 Year 4

Revenues

6) Do you plan to introduce an innovative solution, now or during the follow-on investment, to a current
problem you face? This includes but not limited to digitization, information technology, agricultural
solutions using renewable energy.

7) Six Month Work Plan:

Please provide a month-by-month workplan for the next six months for your business. What do you need to
do in the next six months to ensure your business is best suited for success?

D. GRANT BUDGET

1) Estimate the budget needed to make the enterprise investment ready as discussed under (C) above. Please
fill in the budget template below.

(Attach a proposed budget with narrative).

2) What will the organization contribute to make the enterprise investment ready (e.g., cash (including loans),
land, labor, existing infrastructure, etc.)

Amount requested from USADF: ______________ (in local currency)

*Enterprise contribution: _______________ (in local currency)

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 USADF GRANT APPLICATION

*Contribution from the proposing enterprise. May be in cash donations or in kind, including, but not
limited to, supplies, infrastructure, volunteer labor, office, storage and meeting space, and organization
operating costs not covered by the grant.

3) Will any other groups be involved in providing technical support or funding for this project? If so, list the
organization and the nature of the support.

E. SUPPORT DOCUMENTS

1) Provide a copy of your organization or enterprise registration document and articles of incorporation.
(Required)

2) If available provide copies of the past two years of financial statements.

3) If applicable, provide copies of business bank statements for the last 12 months and/or business mobile
money transfer statements for the same period

4) If available provide a copy of your most recent business plan.

5) Provide authenticated document of ownership e.g. shareholding certificate

Provide three reference contacts. (Required)

Please list the three references outside your organization:

Name Relationship Telephone E-mail

6) Provide a list of main suppliers (if a processor) or buyers (if a supplier).

Name Address Telephone E-mail

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 USADF GRANT APPLICATION

    Name of Project    
    Costs  
  Category Description in KES*  
  A TRAINING    
  A.1      
  A.2      

Sub-Total
     
  B TECHNICAL ASSISTANCE  
  B.1  
B.2

     Sub-Total  

  C ADMINISTRATIVE SUPPORT  
  C.1 used for:  
  C.2 used for:  

Sub-Total
     

   
     
     
Grand Total
       

*KES = Kenyan Shilling

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