3/3/2015 PTS Application

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1 TW11/1008 BASIC PROJECT INFO EOI Num: BASIC DETAILS Title of Proposed Evaluation Study Country(s) Where the intervention that will be targeted by the proposed takes place Select one or more regions and THEN select one or more countries. (NB: Selecting further regions will clear UNSAVED country selections. First country per region is bolded in orange.) Region East Asia and Pacific Europe and Central Asia Latin America and Caribbean Middle East and North Africa South Asia Sub Saharan Africa Country/s ORGANISATIONAL INFORMATION Implementing Agency Programme/Intervention that is being proposed for the evaluation: Name of implementing agency(ies) (non/governmental entity implementing the programme or intervention to be evaluated) Type of implementing agency (governmental, non governmental/other) Name of program or intervention(if available) Program or implementing agency web address if available Organisation Where the Proposal preparation grant will be held if granted by 3ie Legal name 1 Type of organisation If other, please specify: Division or department Country of registration Website Organisation's legal status Contact person details (contract signatory) If other, please specify: First Name Surname Address Country Dial Code Area Dial Code(If applicable) Phone Number Mobile/Cell Phone 1/5

2 Verification We certify that we have reviewed 3ie s grant agreement documents available on the 3ie website and confirm that the grant holding organisation agrees to the terms of the documents. Yes Membership Which, if any, type of member of 3ie is the grantholding organisation Member Associate Member Neither If Member or Associate Member, please select the name from the Member or Associate Member list Is the implementing agency implementing the intervention a Member or Associate Member of 3ie Yes No If yes, please select the name from the Membership list METHODOLOGY AND QUALIFICATIONS The proposed evaluation method that will be pursued in the evaluation (if known) Please tick one or more intended methodologies Randomized control trial (or randomized assignment) Natural Experiment Quasi experimental (propensity score matching) Quasi experimental (instrumental variables) Quasi experimental (regression discontinuity design) Quasi experimental (difference in difference with matching) Quasi experimental (difference in difference without matching) Interrupted time series Single difference Case control Other (please specify) If OTHER was ticked, please specify [up to 200 characters]: Proposed/preliminary impact evaluation approach We recognize that this is an expression of interest for undertaking an impact evaluation in the area of sanitation and hygiene that is relevant to WSSCC. Please describe briefly and to the extent possible, the impact evaluation approach proposed in the study. Please also describe the use of any existing data already available [up to 500 words]. Relevant sectoral expertise, including in sanitation and hygiene Please briefly describe the experience of the Principal Investigator(s) (PIs) in leading and contributing to rigorous impact evaluations, using experimental and/or quasi experimental study methods, in the area of sanitation and hygiene, and in the countries being targeted by this proposal [300 words]. Potential partner organisations 2/5

3 Describe the team s commitment towards equity and diversity, including experience in collaborating with developing country researchers. Please indicate any potential partner organisations for the impact evaluation especially those located within the targeted country (ies) [up to 300 words] Relevance Specify how the intervention/programme is relevant to WSSCC s activities and the knowledge gap that the evaluation will address [up to 300 words] Time period and engagement Indicate the period of time during which the full impact evaluation study is likely to occur (please start with inception (proposal preparation phase) and count up until final report expected date), including an indicative timeline showing when the different sources of data/information will be collected and used [300 words]. Please indicate the proposed approach to engaging with WSSCC and 3ie. [up to 300 words] BUDGET Summary of Resources Required for Project The maximum budget for the proposal preparation grant is USD 30,000. Please download the Excel budget template from the 'Uploads' tab. Complete the budget according to the budget guidelines provided in the document, while paying careful attention to the 3ie direct and indirect cost policies on the 3ie website. In particular, note that 3ie will not fund any part of the intervention itself. Upload the budget and the accompanying Budget Narrative document. Enter the amounts from the Financial Summary worksheet in the table (here). Fund Heading 3ie Contribution Other Contributions Total % Total Personnel Consultancy Travel Survey Cost Office Expenses Equipment Sub grantee direct cost Grantee indirect cost Sub grantee indirect cost Total TEAM PI and STAFF Contact Information Communication regarding this application, and if awarded, the grant, will be sent to the lead principal investigator and the contract signatory. You must load physical addresses for the lead principal investigator and contact individuals in addition to the information requested below. To do so, please click on the "+Address" hyperlink next to the record once added. In addition, the applicant may also designate one additional contact person to be copied on communication only. Name Title Role Address Postal Address Contact Phone Number Skype ID, if available Lead PI +Address 3/5

4 Contrac Contact Staff Duties Please present the names, roles and responsibilities of each post, including for all principal investigators in the table below. If the individual s name is not yet known, please indicate the position, such as research assistant. All principal investigators named in the application will be named as principal investigators in the grant agreement, and changes will be subject to requests for Letters of Variation. Curriculum vitae (CV) for each of the named principal investigators, including the lead principal investigator named in the contact information section below, must be uploaded on the Uploads tab. Each CV should not exceed three pages and should highlight this information: Research experience and up to five publications directly related to impact evaluation, ideally with a focus on the geographic and sectorial context in which the prosed research will take place. Information on success in communicating findings and facilitating policy uptake. A history of collaboration with L&MIC PIs, researchers, and research or academic organisations should be highlighted. To be acknowledged as a L&MIC country researcher, all three of the following conditions need to be fulfilled: The researcher needs to be a L&MIC national. The researcher needs to be physically located in an L&MIC. The researcher needs to be affiliated to an organisation that is registered in a L&MIC. Please note that 3ie requires that there be at least one L&MIC researcher in the evaluation team who is involved in a substantial capacity i.e. as a PI or a lead PI. Please pay special attention to describing the duties of this researcher(s). When you click on + below, the system will begin by asking you for the address in order to check whether the person is already in our system. You will then be able to enter the required information. Role Title Name C K Primary Number Duties Contact Country of Developing organisational of days of the details, the primary country affiliation person will work on project person including organisation researcher? phone number and/or Skype ID UPLOADS Only the following file types are to be uploaded: doc, docx, xls, xlsx, pdf, ppt, pptx, dta, sav, txt, tc, msg, oft, html, zip, rar. Also, file sizes must be less than 10MB each. CV(s) CV (s) of all listed Principle Investigators Previous evaluation studies Examples of relevant Evaluation studies produced by Principal Investigators Budget Budget Narrative & Detailed Budget Supplemental information Additional information about intervention, evaluation design or theory of change, if applicable 4/5

5 Documents and Templates to Download Download our guideline budget template. (Excel format) The template will assist you to supply a budget in a standard format suitable for our review teams and the system. Download a very simple guideline CV template. (Word format) 5/5

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