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Request for Proposals - Aurat Foundation

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(6)<br />

Initial Environmental Examination Form<br />

Gender Equity Program<br />

Grant # , (Grant Title)<br />

A. Applicant in<strong>for</strong>mation<br />

Contractor/grantee<br />

(organization)<br />

Individual contact<br />

and title<br />

Activity (brief<br />

description)<br />

Address, phone<br />

and email<br />

(if available)<br />

Amount<br />

Location of activity<br />

Start and end date<br />

of activity<br />

B. Activities, screening results, and recommended determination<br />

TABLE 1<br />

Proposed Sub-activities<br />

Screening result<br />

(Step 3 of instructions)<br />

Very Low Risk<br />

Moderate Risk<br />

High Risk<br />

Recommended Determinations<br />

(Step 6 of instructions. Complete<br />

<strong>for</strong> all moderate and high-risk<br />

activities)<br />

No significant<br />

adverse impact<br />

With specified<br />

mitigation, no<br />

significant<br />

adverse impact,<br />

Significant<br />

Adverse<br />

impact<br />

22

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