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Appendix A: Operational Forms

How to use: These 10 forms are designed to be photocopied and used in managing a CED project. Print them BEFORE a project launches. Keep 20 copies of each in the CED coordinator's document kit (Chapter 6). Every form works on paper or in digital form.

List of forms

  1. Club area diagnosis sheet (Chapter 3)
  2. Members' CED skills matrix (Chapter 7)
  3. Community Needs Assessment report: template (Chapter 9)
  4. CED Global Grant concept note: outline (Chapter 16)
  5. Standard CED Global Grant budget (Chapter 16)
  6. Partnership MOU (Chapter 19)
  7. Beneficiary register (Chapter 22)
  8. CED project financial ledger (Chapter 22)
  9. CED after-action report (Chapter 23)
  10. M&E tracking grid: baseline / mid-term / endline (Chapter 22)

Form 1: Club Area Diagnosis Sheet

Use: Strategic mapping of the club's area of action. Updated every year by the CED coordinator.

Identification

Rotary Club of: ____ District: ___

Area covered: _______

Estimated total population: ________

Valid from: _/_/__ to __/_/___

CED coordinator in charge: _______

Layer 1: Populations

Category Estimated number Sources
Total population ______ ______
Population living in poverty ______ ______
Young people < 25 not in employment or training ______ ______
Women heads of household ______ ______
People with disabilities ______ ______
Refugees or displaced people (if applicable) ______ ______
Other vulnerable groups ______ ______

Layer 2: Economic activities

Sector Weight Comments
Farming / livestock ______ ______
Informal trade / markets ______ ______
Crafts ______ ______
Services ______ ______
Industry / processing ______ ______
Other ______ ______

Layer 3: Economic infrastructure

Type Condition Comments
Markets ☐ Sufficient ☐ Insufficient ☐ None ______
Access roads ☐ OK ☐ Fair ☐ Poor ______
Electricity ☐ OK ☐ Intermittent ☐ None ______
Mobile connectivity ☐ OK ☐ Fair ☐ Poor ______
Storage/processing ______ ______

Layer 4: Institutions

Type Present in the area Comments
Banks ______ ______
MFIs ______ ______
Active cooperatives ______ ______
Chamber of commerce ☐ Yes ☐ No ______
Chamber of trades ☐ Yes ☐ No ______
Chamber of agriculture ☐ Yes ☐ No ______
Vocational training bodies ______ ______
Public econ. dev. services ______ ______

Layer 5: Networks

Type Actors identified Comments
CED NGOs present ______ ______
Local associations ______ ______
Active diaspora ______ ______
Other nearby Rotary clubs ______ ______
Universities, institutes ______ ______

Needs × capacities × CED opportunities matrix

# Need identified Local capacities CED opportunity Priority
1 ☐ High ☐ Medium ☐ Low
2 ☐ High ☐ Medium ☐ Low
3 ☐ High ☐ Medium ☐ Low
4 ☐ High ☐ Medium ☐ Low
5 ☐ High ☐ Medium ☐ Low

Three priority opportunities for the club

Opportunity no. 1: _______ Potential partners: ______ Family of intervention (M/F/V/C/L): ____

Opportunity no. 2: _______ Potential partners: ______ Family of intervention: ___________

Opportunity no. 3: _______ Potential partners: ______ Family of intervention: ___________

Signatures: CED coordinator ___ President __ Date ____

Form 2: Members' CED Skills Matrix

Use: Mapping of the skills and capital the club can draw on. Updated every year.

Club: ___ Rotary year: ___

Consolidated table (one row per member surveyed)

Name Profession Primary CED skill Secondary skill Languages Availability (hrs/yr) Restrictions Declared conflict of interest

Skills summary

Skill Number of members
Finance / accounting / audit ____
Legal (business law, OHADA, cooperatives) ____
Banking / microfinance ____
Entrepreneurship / business management ____
Training / instructional design ____
Agriculture / agronomy ____
Construction / engineering ____
Communication / advocacy ____
Medical / health ____
Digital / information systems ____
Professional foreign languages ____

Professional networks available

Member Network/organization Type of resource available

Strategic dual memberships

Member Outside affiliation Role Designated liaison?
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No

Signatures: CED coordinator ___ Date _____

Form 3: Community Needs Assessment Report (Template)

Use: Template for the CNA report to attach to every Global Grant application. Adapt it to each project.

1. Executive summary

Context, community concerned, CNA period, methodologies used, main findings (3-4 bullet points), recommendations for the project.

2. Context and methodology

2.1 Host club and partners

Host club: ____ Local partner: ___ International partner club (if identified): __ Methodology(ies) used: ___ Data collection period: from // to //

2.2 Geographic area

Description: ________ Rationale for the choice: __________

2.3 Methodologies (check and describe)

  • ☐ Community meeting (number: ___ / participants: ___)
  • ☐ Asset inventory
  • ☐ Survey (number of households: ___)
  • ☐ Interviews (number: ___)
  • ☐ Focus groups (number: ___ / composition: _____)
  • ☐ Community mapping

2.4 Methodological limitations

Statement of the limitations and biases identified:

3. Community profile

3.1 Demographics

Total population: __ Median age: __ % women: __ Share under 18: __ Share over 60: _____

3.2 Economy

Main activities: _______ Estimated informality rate: _ Median income: __ (measurement method: ______)

3.3 Infrastructure

Access to safe water: __ Access to electricity: _ Access to passable roads: ___ Accessible financial services: __ Training services: ____

3.4 Institutions present

3.5 Vulnerabilities identified

4. Needs identified

# Need Priority as seen by the community Triangulated priority Most affected subgroups
1 ☐ High ☐ Medium ☐ Low ☐ High ☐ Medium ☐ Low
2 ☐ High ☐ Medium ☐ Low ☐ High ☐ Medium ☐ Low
3 ☐ High ☐ Medium ☐ Low ☐ High ☐ Medium ☐ Low
4 ☐ High ☐ Medium ☐ Low ☐ High ☐ Medium ☐ Low
5 ☐ High ☐ Medium ☐ Low ☐ High ☐ Medium ☐ Low

5. Existing capacities and assets

5.1 Human assets

5.2 Physical assets

5.3 Natural assets

5.4 Institutional assets

5.5 Financial assets

6. Opportunities and potential solutions

6.1 Solutions identified by the community

6.2 Solutions proposed by institutional actors

6.3 Options by CED family

  • Family M (microfinance): __________
  • Family F (training): ______
  • Family V (value chains): _____
  • Family C (cooperatives): _________
  • Family L (integrated local dev.): __________

7. Recommendations

7.1 Suggested family of intervention

7.2 Priority target groups

7.3 Strategic partners to engage

7.4 Risks identified and mitigation

Risk Probability Impact Mitigation
☐ H ☐ M ☐ L ☐ H ☐ M ☐ L
☐ H ☐ M ☐ L ☐ H ☐ M ☐ L
☐ H ☐ M ☐ L ☐ H ☐ M ☐ L

8. Annexes

  • Survey questionnaire (annex A)
  • Focus group guides (annex B)
  • Institutional interview guide (annex C)
  • Anonymized raw data (annex D)
  • Community mapping maps (annex E)
  • Photos (with consent) (annex F)
  • List (anonymized if needed) of people met (annex G)

Signatures: CED coordinator __ Local partner __ Date _

Form 4: CED Global Grant Concept Note (Outline)

Use: Outline aligned with the TRF template in the Grant Center. Write it in English for submission; the executive summary may be translated.

Project information

  • Project title: ________
  • Host club / district: ________
  • International partner club / district: ______
  • Area of Focus (primary): Community Economic Development
  • Secondary Areas of Focus: ______
  • Geographic scope: ________
  • Total budget (USD): _____
  • TRF amount requested: _____
  • Start date: __ End date: __

1. Project description (2-4 pages)

Problem, target population, intended outcomes, theory of change.

2. Community

Demographics, economic profile, vulnerabilities, context, based on CNA.

3. Partners

  • Host Rotary club and its capabilities
  • International partner Rotary club and its engagement
  • Cooperating organizations (local technical partners, authorities)
  • RAGCED involvement if applicable

4. Project objectives and activities

  • Outcome 1: ____________
  • Outcome 2: ____________
  • Outcome 3: ____________
  • Activities linked to outcomes
  • Timeline
  • Deliverables

5. Budget

Line-by-line, with category totals. Admin ≤ 3%. Contingency ≤ 10%.

6. Standardized measures and M&E plan

List of the CED Rotary Standardized Measures adopted, plus project-specific indicators.

7. Sustainability

An explicit sustainability model: own revenue, partner institution, public policy, knowledge transfer. Post-closure indicators at 12-24 months.

8. Community involvement

Formal mechanisms for community participation in design, implementation and evaluation. Grounded in the CNA.

9. Required documentation attached

  • CNA report
  • Detailed budget
  • Monitoring and Evaluation Plan
  • MOU with cooperating organizations
  • Support letters (local authorities, institutional partners)
  • Pledge letters from cofunding sources

Form 5: Standard CED Global Grant Budget

Use: Standard budget structure. Adapt it to the project. Always line by line.

Category Description Unit cost Quantity Subtotal (USD) Source (TRF / DDF / club cash / in-kind)
1. Community Needs Assessment (if eligible)
2. Infrastructure / equipment
3. Consumables / supplies
4. Training / capacity building
5. Local project staff
6. Transport and logistics
7. Communication / project visibility
8. Monitoring and Evaluation
9. Administration (≤ 3% of total)
10. Contingency (≤ 10% of total)
TOTAL PROJECT

Cofunding summary

Source Amount (USD) Match ratio World Fund match
DDF host district 1:1
DDF international district 1:1
Cash host club 0.5:1
Cash international club 0.5:1
In-kind (valued) 0 0
TOTAL PROJECT FUNDING

Form 6: Partnership Memorandum of Understanding (MOU)

Use: A simple one-page template for an operational partnership; expand it as complexity requires (see Chapter 19).

MEMORANDUM OF UNDERSTANDING

Between:
ROTARY CLUB of ________________________________
Represented by ______________________, President
Address: _______________________________________

And:
[ORGANIZATION NAME] ____________________________
Represented by ______________________, [Role]
Address: _______________________________________

ARTICLE 1: PURPOSE
The parties agree to cooperate on a Community Economic Development
project in _________________________, aimed at ________________________.

ARTICLE 2: DURATION
From ___/___/______ to ___/___/______ (____ months), renewable by
written agreement.

ARTICLE 3: ROTARY CLUB COMMITMENTS
1. ___________________________________________________
2. ___________________________________________________
3. ___________________________________________________

ARTICLE 4: PARTNER COMMITMENTS
1. ___________________________________________________
2. ___________________________________________________
3. ___________________________________________________

ARTICLE 5: FINANCIAL ARRANGEMENTS
Total budget: ____________ USD
Rotary contribution: ____________ USD
Partner contribution: ____________ USD
Disbursement schedule: ____________

ARTICLE 6: GOVERNANCE
Meetings: ☐ Monthly ☐ Quarterly ☐ Ad hoc
Point of contact Rotary: ______________________ Phone: ______________
Point of contact Partner: _____________________ Phone: ______________

ARTICLE 7: REPORTING
☐ Monthly narrative reports
☐ Quarterly financial reports
☐ Final report within 60 days of project end

ARTICLE 8: COMMUNICATION AND VISIBILITY
Both parties commit to mutual mention in communications. Photos of
beneficiaries require written consent.

ARTICLE 9: DISPUTES
Any dispute will be resolved amicably first, then through the District
Rotary Foundation Committee if unresolved.

ARTICLE 10: TERMINATION
Either party may terminate with ____ days written notice.

Signed in two copies:

For the Rotary Club:                   For the Partner:
______________________                  ______________________
Name, title                             Name, title
Date: __________                        Date: __________

Witness:                               Witness:
______________________                  ______________________

Form 7: Beneficiary Register

Use: A register that can be anonymized depending on circulation. Sensitive personal data: restricted access.

Project: _____ Period: from _/_/ to _/_/ Register keeper: ____

# ID Full name Sex Age Town / neighborhood Specific vulnerability Service(s) received Date Beneficiary signature
1
2
3
4
5
6
7
8
9
10

Consent collected: ☐ Written ☐ Oral, documented Retention: at least 5 years after project closure Access: CED coordinator + Finance & stewardship portfolio only

Form 8: CED Project Financial Ledger

Use: Daily ledger of the project's financial transactions. Two signatures for every disbursement.

Project: _____ Dedicated account: ______ Period: Month of __ Year __

Receipts

Date Source Amount (local currency) Amount (USD) Reference Person responsible

Total receipts for the month: ______

Payments

Date Budget line Supplier / payee Purpose Amount (local currency) Amount (USD) Voucher no. Signatures (2)

Total payments for the month: ______

Balance

Opening balance: __ + Receipts: _ − Payments: ___ = Closing balance: ______

Bank reconciliation done on: // by ______

Form 9: CED After-Action Report (AAR)

Use: Project debriefing, within 6 weeks after closure. See Chapter 23.

Project: _____ Debriefing date: // Facilitator: ____

Participants

Role Name Organization
CED coordinator Host club
Finance portfolio Host club
Field portfolio Host club
Comms portfolio Host club
President Host club
Foundation Chair Host club
Representative Local partner
Representative International club
DRFC Host district

Question 1: What worked well

Question 2: What did not work

Question 3: Lessons about CED

Question 4: Lessons about our club

Question 5: Lessons about our partners

Question 6: Handover to the next project

Question 7: Concrete actions for the next 12 months

# Action Person responsible Deadline
1
2
3
4
5

Report written on: //__ Written by: ______

Filed in the club's handover folder: ☐ Yes

Form 10: M&E Tracking Grid

Use: Consolidated table of all indicators. Updated every quarter.

Project: _____ M&E lead: ________

Outcomes

Outcome Indicator Unit Baseline (M0) M6 M12 M18 M24 M30 Endline target Method
1
2
3

Outputs

Output Indicator Unit M3 M6 M9 M12 M15 M18 Final target
1
2
3

Safeguarding indicators (if applicable: microfinance, gender, children)

Indicator Alert threshold Current value

Comments on variances

Updated: //__ By: ______

Appendix A: Operational Forms, Rotary Club Guide: Community Economic Development