Partner with us

للتعاون مع ساما وتحقيق أثر أكبر

كمنظمة منفذة في السودان: انضموا لتحالف الاغاثة الانسانية و اعادة الاعمار في السودان المبني على التعاون والقيم المشتركة

كجهة داعمة للتمويل: شاركوا في دعم تنفيذ المشاريع عبر ساما أو أحد شركاء التحالف

معًا، نحقق التغيير، تعرفوا أكثر على التحالف هنا

Partner with SAMA to create a greater impact:

1. As an implementing organization in Sudan: Join our alliance built on shared values and collaboration.
2. As a funding partner: Support project implementation through SAMA or an alliance member.

Together, we make a difference. Learn more about the alliance here.

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Why are you filling out this form? *

• Delivering Healthcare at Aldebba Camp, Northern State
• Mobile Clinic and Outbreak Response in Tawila
• RFP – Others

Organization Information and Due Diligence

Organization Name اسم المنظمة *

Year of Establishment: *

Headquarters Location *

• United States
• International
• Sudan

Organization Headquarters Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

— Select country —AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountry

Organization Headquarters Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Website URL *

Type NA if not applicable

Facebook *

type NA if not applicable

Briefly describe your organization’s work, highlighting your core activities and recent experience—especially in implementing Moblie Clinic *

Briefly describe your organization’s work, highlighting your experience in delivering healthcare to underserved communities *

Is your organization registered in Sudan? *

• Yes
• No

Please upload the organization registration in Sudan *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Has your organization received and managed international donor funding before? *

• Yes
• No

How did your organization receive international donor funds? Please describe the method(s) used and indicate the currency and type of account used. *

If yes, list donors *

Please upload the organization most recent Annual report *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Please upload the organization most recent audited financial statement *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

What was the organization's total revenue for the year 2025? *

Please provide a list of the names and roles of the organization's Board of Directors or Executive Committee members?

Full legal name *

Role *

Do you currently have an active presence in Tawila or surrounding areas? *

• Yes
• No

Primary Contact Person المسؤول الرئيسي للتواصل

Contact person name اسم مسؤول التواصل *

First

Last

Position المنصب *

type NA if not applicable

Contact person email البريد الإلكتروني *

Contact person WhatsApp واتساب مسؤول التواصل *

Please upload a copy of your ID يرجى ارفاق نسخة من بطاقة الهوية الخاصة بك. *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

About the project (Mobile Clinic and Outbreak Response)

Please write your experience in operating a mobile clinic? يرجى كتابة خبرة المنظمة في تشغيل عيادة متنقلة؟ *

What is the title of your proposed project? ما هو عنوان مشروعك المقترح؟ *

Briefly describe the objective of your project. اذكر/ي باختصار هدف مشروعك. *

What is the location of the project? and Why? ما هو موقع المشروع؟ ولماذا اخترت هذا الموقع؟ *

What specific sites (e.g., IDP camps, shelters, schools) will your project target? Please justify your selection. ما هي المواقع المحددة (مثل: معسكرات النازحين، الملاجئ، المدارس) التي سيستهدفها مشروعك؟ يرجى تبرير اختيارك. *

Who is your project targeting? من هم الفئات/الأشخاص المستهدفون في مشروعك؟ *

Describe your approach to operating the mobile clinic 5 or 7 days per week? صِف نهجك في تشغيل العيادة المتنقلة لمدة 5 أو 7 أيام في الأسبوع. *

How will you ensure outbreak preparedness, including malaria and cholera surveillance, as the rainy season approaches?كيف ستضمنون الاستعداد لمواجهة تفشي الأمراض – بما في ذلك ترصد الملاريا والكوليرا – مع اقتراب موسم الأمطار؟ *

. How will you conduct community health education sessions and engage the displaced community ?كيف ستُجري جلسات التثقيف الصحي المجتمعي وتُشرك مجتمع النازحين؟ *

Describe your implementation plan including timeline. activities, key milestones and expected start and end dates. اشرح/ي خطة التنفيذ الخاصة بك بما في ذلك الجدول الزمني، والأنشطة، والمعالم الرئيسية، وتواريخ البدء والانتهاء المتوقعة. *

Provide an overview of your staffing structure. Who will lead and manage the project locally? قدّم/ي لمحة عن هيكل الكادر/الطاقم في مشروعك. من سيقود ويدير المشروع محليًا؟ *

What are the security measures that you will undertake to ensure the staff and beneficiaries safety? ما هي التدابير الأمنية التي ستتخذونها لضمان سلامة الموظفين والمستفيدين؟ *

Please describe how you will procure the items related to the health services that will be provided in the clinic *

Could you please provide a detailed plan fow how you will manage complicated cases that needs to be referred to a bigger health facility *

Has your organization already identified or established relationships with suppliers capable of providing medications and supplies for the clinic *

• Yes
• No

If yes, please provide details including supplier names, locations, and past collaboration history *

your the العمر)؟

If no, please describe in detail how your organization will identify, vet, and contract such suppliers *

Are you able to procure ITN (ناموسية) *

Outline your timeline for the clinic to be ready to operate? حدد الجدول الزمني لتجهيز العيادة للعمل *

Explain your risk and security management measures for operating in unsafe/remote areas ? شرح تدابير إدارة المخاطر والأمن المتبعة للعمل في المناطق غير الآمنة أو النائية *

Explain how you will be able to handle Outbreak Cases? اشرح كيف ستتمكن من التعامل مع حالات تفشي المرض. *

What criteria will you use to identify and select beneficiaries for the net distribution ? and how are you planning to identify those beneficiaries? ما هي المعايير التي ستستخدمونها لتحديد واختيار المستفيدين من توزيع الناموسيات في المواقع المستهدفة؟ وكيف تخططون لتحديد هؤلاء المستفيدين والتحقق من أهليتهم؟ *

How will you collect and verify beneficiary data (e.g., name, gender, age)? كيف ستقومون بجمع والتحقق من بيانات المستفيدين (مثل: الاسم، النوع/الجنس، العمر)؟ *

What challenges do you anticipate in implementing this project, and how will you address them? ما هي التحديات التي تتوقعونها في تنفيذ هذا المشروع، وكيف ستتعاملون معها؟ *

Please describe your plan for producing and providing marketing materials, including photos and video documentation, to showcase project activities and outcomes يرجى وصف خطتكم لإنتاج وتقديم المواد التسويقية، بما في ذلك الصور وتوثيق الفيديو، لإبراز أنشطة المشروع ونتائجه. *

Attestations

Legal Status *

• We are a legally registered organization in Chad and authorized to operate in Adre.

Political Neutrality *

• We confirm that our organization is politically neutral. We do not support or oppose any political or military group or agenda, and we will deliver assistance solely based on humanitarian need.

Inclusivity and Non-Discrimination *

• We will ensure fair and equitable access to services regardless of ethnicity, gender, age, religion, displacement status, or political affiliation, with specific attention to the most vulnerable.

Safeguarding and Protection *

• We confirm that we have safeguarding policies and procedures in place, including PSEA, child safeguarding, gender inclusion, and we will apply survivor-centered, trauma-informed approaches—especially for GBV-related services.

Data Protection and Confidentiality *

• We confirm that we will collect and store beneficiary data safely, maintain confidentiality, and ensure informed consent, particularly for women and GBV survivors.

Video documentation التوثيق بالفيديو *

• I understand that I am required to provide at least one (1) short video testimonial from project beneficiaries on the ground. أفهم أنني مطالب/ة بتوفير ما لا يقل عن فيديو قصير واحد (1) لشهادة/إفادة من مستفيدي المشروع على أرض الواقع.

Photo documentation التوثيق بالصور *

• I understand that I am required to provide at least ten (10) photographs documenting the project activities, ensuring they are captured with the best quality possible. أفهم أنني مطالب/ة بتوفير ما لا يقل عن عشر (10) صور فوتوغرافية توثّق أنشطة المشروع، على أن يتم التقاطها بأفضل جودة ممكنة.

Reporting التقارير *

• I understand that I am required to submit a report detailing both the narrative and financial aspects of the activities no later than one (1) week after the completion of the project activities. أفهم أنني مطالب/ة بتقديم تقرير يوضح الجوانب السردية/الوصفية والمالية للأنشطة، وذلك في موعد لا يتجاوز أسبوعًا واحدًا (1) بعد اكتمال أنشطة المشروع.
• I will comply with and use the project report template provided by SAMA when preparing and submitting my report. سألتزم باستخدام نموذج تقرير المشروع الذي توفره منظمة SAMA عند إعداد وتقديم تقريري.

Future funding disqualification الحرمان من التمويل المستقبلي *

• I understand that failure to deliver the project or report as agreed may result in disqualification from future funding and/or a request to return the grant funds. أفهم أن عدم تنفيذ المشروع أو تقديم التقرير كما هو متفق عليه قد يؤدي إلى حرماني من التمويل المستقبلي و/أو طلب إعادة أموال المنحة.

SAMA Policies سياسات جمعية ساما *

• I agree to adhere to SAMA’s confidentiality and code of conduct policies

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