Project Proposal Application

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Name of the project *

First name of main contact *

Last name of main contact *

Phone number * Please enter country code with number

Email *

Title and role in the project *

City of current Work Place *

Country of current Work Place *

Describe the problem *

Describe the solution *

Describe the scope of the project, number of cases or benificiaries or locations *

List the approximate cost per case or beneficiary (total project/equipment cost) *

How can you help PAMA? *

It has specific and measurable results Its outcomes are achievable in Palestine and with PAMA’s help It addresses problems that can’t wait and has negative consequences It addresses problems not readily solvable within local institutions It benifits patients who can’t afford the service provided t services a group of patients rather than individual cases t addresses a problem that is prevalent, treatable and of high impact on patients and communities. It has direct services to patients “screening, diagnostics, therapeutics, surgeries, etc.”

Comments *

Signature *

Date *

By submitting this application you verify that all information included are accurate, please assure the your contact info provided are accurate and up to date. PAMA will review applications between July 1st and Nov 1st of every year, PAMA will contact you if further info or documents are needed. By the end of the year PAMA will inform you should your project be approved for funding