APPLICATION ID: 545665

CONRAD N. HILTON FUND FOR SISTERS

30440 Agoura Road, Agoura Hills, California 91301 USA
818-483-0485 Fax: 818-851-3895 www.hiltonfundforsisters.org

GRANT APPLICATION

FUNDING CHECKLIST

Please review ALL of the items below and check the boxes in order to proceed.

✔ 1. This request meets one of the criteria for eligibility.

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✔ 2. This request addresses at least one of our Funding Priorities.
✔ 3. The proposed budget amount for this request does NOT exceed $15,000. OR If this is a pre-
authorized request for emergency funding, it does not exceed $10,000.
✔ 4. This request does NOT include any item on our List of Restrictions.
✔ 5. This organization has NOT received a previous grant from the Conrad N. Hilton Fund for
Sisters in less than ONE (1) FULL YEAR. If there was a previous grant, the grantee has
successfully completed the grant reporting process and received a confirmation that the file
has been closed.
✔ 6. This organization has NOT received three (3) grants within a ten (10)-year period.

PRIMARY SISTER CONTACT

Primary Sister Contact

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Country of Applicant: India
Region of Applicant: Latin America, Caribbean, India

First Name: Annie Last Name: Porunnolil

Educational Background related to the project:
SRN(London) BA.BEd (India) Administrator of Projects

Experience/Skills sister brings to the project:

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Has been as a staff at Mercy Home since 2016 and superior of Mercy Home since 2019January

Months/Years directly involved in the project:

from 2016 January

Street Address: P.Kamdouveng,

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City/Town/Village: Tuibuang State: Manipur

County/District: ________________________________________________________________________
Churachandpur
Postal Code: 795128 Country: India
Telephone: 08131058587 Email: mercyhome91@gmail.com
Retype Email: mercyhome91@gmail.com
Postal Address
✔ Postal address, telephone and email are the same as above.

If the address is different from above, please complete the section below:
Mercy Home
P.Kamdouveng,
Tuibuang,Churachandpur.
Manipur 795128. India

Alternate Email: aniepofccl@gmail.com

Retype Email: aniepofccl@gmail.com

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I understand that the Primary Sister Contact must be a religious sister recommended by a
congregational leader or a member of the leadership team. I am aware that all automated
✔ notifications will be sent to the main email entered on this page. I also acknowledge that the
Primary Sister Contact is responsible for signing and submitting the Grant Application with
supporting documents, Grant Agreement, Grant Evaluation Report and Monitor/Guarantor
Report Form for projects outside the U.S. at the appropriate times.

CONGREGATION

Congregation
Congregation Name: Franciscan Clarist Congregation, FCC
Congregation Initials: FCC
Congregation Scope: International
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Congregation Type: Pontifical
Name of Bishop if your congregation is Diocesan:
Diocese where congregation’s main headquarters
Is located: Arch diocese of Ernakulam Kerela state .
Founder/Foundress: Bishop Lavinge
Date congregation was founded: 1888
In what country was your congregation founded: India
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Brief description of main charism(s):
to follow Jesus,poor humble and crucified living the Gospel values in loving service to all specially the poor,

Website: Fccongregation.Org

Congregational Leader
First Name Last Name/Surname/Family Name
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Current Sister: Ann Joseph

Previous Sister: Sinclare Mother
Street Address: FCC generalate,Portiuncula.Kerela
City/Town/Village: Ashokapuram, Aluva - 1
State: Kerala Postal Code: 683101
Country: India
Telephone: 0484-2838588 Email: fcgeneralate@gmail.com
Retype Email: fcgeneralate@gmail.com
Member of Leadership Team (i.e. Provincial, Regional, Visitatrix, etc.) if any
First Name: Annie Last Name: Kalapurackaparambil
Official Title of
Leadership Team Member: Sister Provincial
Select Province or Region: Province
Other Province or Region:
Name of Congregational
Province or Region (if any): St.Clare Province Imphal
Congregational Province or
Region Address: Clarist Home ,Mantripukhri P.O
City of Provincial or Regional Center: Imphal

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State: Manipur Country: India
Telephone: 0385-2427486 Email: fccimphal@gmail.com
Retype Email: fccimphal@gmail.com

Letter of Support from Congregational Leader OR Member of Leadership Team named above
Scan and/or save the Letter of Support onto your computer.
Then click on the “Choose File” button to upload it to your
application. DO NOT email this document as a separate
attachment to HFS. If you need more instructions for uploading
documents, please click here.

Leadership Conference
Is your congregational leader a member of the conference?
Name of Leadership Conference: Conference of Religious in India

Title:
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First Name: BR.T.Amalan
President
Last Name: FSC

Email: tamalanssc@gmail.com Retype Email: tamalanssc@gmail.com

Website: www.cridelhi.org

I understand that my application will NOT be considered for funding if I do not provide a Letter
of Support from my congregational leader or member of the leadership team. I confirm that I
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have given my recommending congregational leader a copy of the Memo of Understanding and
that she has included all the required information in her Letter of Support that has been
attached.
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ORGANIZATION

Organization
Organization Name: Mercy Home Care Centre
Street Address OR P.O. Box: P.Kamdouveng ,
City/Town/Village: Tuibuang
County/District: Churachandpur State/Province: Manipur
Postal Code: 795128 Country: India
Diocese: Imphal
Who owns the facility/building where your project is located? St.Clare Province
Year organization was founded (YYYY): 2000

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Has the organization received a previous HFS grant? Yes
If so, please list the grant numbers and years (If there are more than three (3), list the most recent
ones):
Grant Number: Year:
329365 2016
230577 2014
10543 2009

Organization Background:
Mercy Home Care Centre has the Motto "The Love of Christ Urges Us " 2 Cor 5:14
with a vision of a dignified life for the poor HIV/AIDS affected and infected women and children based on Christian
values.
Our mission is to bring social changes to the deprived community by providing emotional physical social and
educational support and rehabilitation .
Aim and Objectives
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-to uplift and provide appropriate educational service to the HIV/infected and affected and vulnerable children.
-to provide vocational skill training to the HIV affected /infected widows and youth.
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PROJECT

Project
Title of Project: Nutrition education health support of 120 children
Amount Requested: $15000
Project Start Date: 12/14/2019
Last Year This Year Next Year
Number of people who directly benefit from this project:
0 60 120

Purpose

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This grant will be used primarily to fund
Nutrition,education and health of 120 children 6 camps in the villages three health camp 3 awareness program 3
training program . This will accomplish better health and empowerment of women
This will accomplish
To provide text book computer, school uniform tuition fee furnish the the study hall ,purchase educational
materials and sports and games items . This will accomplish better facility

People Served: Who are the people you are serving? Include a description of their living conditions and
local environment. Include the ages of the population served.
The service is extended to Churachandpur District. Mainly in far villages and economically poor area
.From this area needy children are identified and we are giving residential care to the poor orphans down trodden
neglected HIV/AIDS infected /affected children of 16 years at Mercy home . These children are in poor economic
status and unable to meet the expense of education and nutrition . Parents not employed

Poor nutritional status of children of parents whose daily income is meager are given balanced diet
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Home based Rehabilitation service to about 40 children with disabilities in the district .

They unable to give treatment in other hospitals or physiotherapy centers

Physio therapy to 15 children with cerebral palsy and other physical disabilities at the center . Parents are unable to
take to other schools .
Awareness camps and training camps are intended for about 100 people at the centre .
Experts will be invited to give awareness and talk and animation to them.
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Free medical camp and chek up in far village where there is no transport medical
facilities.about 80 people may attend every camp of all age
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Project Situation: What needs or issues are your project addressing?
- We are addressing the health problems of the children and women

- Providing residential opportunities for formal education of poor children

- remove ignorance and create awareness on health hazards

- remove illiteracy of the disabled to enable them to bring to the main stream
unacceptability to the educational institution by providing transport

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Project Activities: Describe the actual tasks you will be able to accomplish with the grant funds. Include
what will be produced through those activities.
To meet the expense of provide residential facility to 60 children meeting expense of food, residential facilities.

Buy Play materials

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to pay the school fee buy uniform book other educational materials

Conduct seminar work shop to improve the personality of children and motivate them.
Take them for educational tour
Buy computer ,other gadgets , book etc for education
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Project Goals/Impact: Describe the goals of this project and the impact you hope this project will have
on the people you serve.
A dignified life achieve self employment
Chance to be professionally qualified and employment
Find meaning in life and service to the society

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Collaboration: If you have formed partnerships with other organizations to meet similar goals, please
name the organization(s).
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Manos Unidas has sponsored the building of Mercy Home

Home of Hope USA for construction of Water tank , Toilet block, Roof top and more rooms
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If HFS is not able to fund the total amount of your request, how will this affect your project?
We will find other organization to help us

funds.
Manou Unidas Spain received in 2017

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List other donors from whom your organization has received funds in the past or is presently soliciting
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Home of Hope 2017,2018
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STAFFING

Sisters Involved In The Ministry

Name Job Titles Hours per Week
Devoted to Project
Primary Sister Contact Annie Porunnolil Project Coordinator 30
Sister Tessy George Administrator, Counselor 30
Sister Angela Baite
Rehabilitation Therapy Assistant 30
Number of Full Time Sisters: 3 Number of Part-Time Sisters: 2

Lay Staff: Paid and Volunteers

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Type of Work Paid Staff Volunteers
Accountant 0 1
Caregiver/Caretaker 3
Cook 2
Doctor 1
Driver 2
Gardener 1 1
Janitor 1
Nurse 2
Secretary 1 1
Security 1
Teacher 1 3
Other:
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GRANT BUDGET

Grant Budget
Project Item Quantity Cost in US Dollars
1. Education of 60 Children admission fee Rs 1500 x 60 90000 $1278
2. Educational materials furniture for study hall etc 24000 $341
3. School Tuition Rs 400 x 60 x 12 288000 $4091
4. Uniform Rs 1000 x 60 60000 $852
5. Food and nutritional support for 60 x 700 x 12 504000 $7160
6. Medical camp 3 x 2000 6000 $85
7. Transportation diesel vehile maintenance 2000 x 12

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24000 $341.00
8. cook salary 12 x 5000 60000 $852
9. $0
10. $0
11. $0.00
12. $0
13. $0.00
14. $0.00
15. $0
16. $0
17. $0
18. $0.00
19. $0
20.
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Total Budget:
$15000
$30000

Documents to Attach:
Estimate/Price Quote: Required only for any ONE (1) item that costs $1,000 or
more. This could be a copy of a pro-forma invoice or any document showing
proof of cost for each item. Multiple documents may be uploaded together if
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there is more than one (1) item.

Download the Supplemental Form by clicking on the button below and save it
onto your computer. Complete the form and resave it onto your computer.
Then upload it to your application by clicking on the “Choose File” button.

I confirm that the total budget is the same as the amount requested and does NOT contain any
items on the HFS List of Restrictions. I also confirm that any required estimate/price quote or
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supplemental form has been attached.

INCOME/EXPENSE REPORT
INCOME Last Year This Year Next Year
Non-Cash Contributions (Donated Materials & Services)
food expense from Farm $200 $220 $520
Rent given $990 $990 $995
sisters salary $2500 $3000 $3500
$0 $0 $0
$0 $0 $0
Non-Cash Contributions Subtotal $3690 $4210 $5015
Cash Income *(DO NOT INCLUDE GRANT FROM HILTON FUND FOR SISTERS)

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Donation and contribution $19579 $25258 $15620
Vocational training Receipt $2554 $1650 $1852
other receipts $33 $1826 $1657
interest received $338 $120 $150
$0 $0 $0
$0 $0 $0
$0 $0 $0
$0 $0 $0
$0 $0 $0.00
$0 $0 $0
Cash Income Subtotal $22504 $28854 $19279
TOTAL INCOME $26194 $33064 $24294

EXPENSES
A Last Year Current Year Next Year
Non-Cash Contributions (Donated Materials & Services)
food expense from Farm $200 $220 $520
Rent given $990 $990 $995
sisters salary $2500 $3000 $3500
$0 $0 $0
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$0 $0 $0
Non-Cash Contributions Subtotal $3690 $4210 $5015
Cash Expenses *(DO NOT INCLUDE GRANT FROM HILTON FUND FOR SISTERS)
Administrative expense $196.00 $857 $857
& Charitable Social $1190.00 $3605 $2300
Repair ,maintenance $600 $800 $900
food Expense $8955 $8597 $9671
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medical $1790 $1074 $1280

education $2180 $3761 $4250
Salary &wages $3590.00 $5373 $5820
$0 $0 $0
$0 $0 $0
$0 $0 $0
Cash Expenses Subtotal $18501 $24067.00 $25078
TOTAL EXPENSES $22191 $28277 $30093
BALANCE (LOSS) $4003 $4787 -$5799
If you are operating at a deficit (loss), please explain what corrective actions have been taken:

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I confirm that the information entered in the Revenue/Income & Expense Report is correct to
the best of my ability and that any budget deficits have been addressed in the section above.

BANKING INFORMATION

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I will be requesting a check be mailed and confirm that I have read and understand the
instructions for the Banking Information.

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I will be requesting a wire transfer be completed and confirm that I have read and understand
the instructions for the Banking Information.

WIRE TRANSFER

Wire Transfer Banking Information

Name of Bank: Vijaya Bank
Name of Bank Branch: Imphal Branch
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Address: Thangal Bazar
City: Imphal
State: Manipur Postal Code: 795003
Country: India
SWIFT Code:
Sort Code: IBAN:
Bank Account Number: 860101011001594
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Complete Congregational Account Holder: Clarist Home Mantripukhri Imphal
Postal address (as listed at the bank) for the Bank Account Holder you provided:
Clarist Home, Mantripukhri, Imphal, Manipur - 795003
If the Account Name is the name of an individual, provide the birth date of that person:

Name of Correspondent Bank:

Applicants from India

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What type of bank account is this? Provincial

Provide the entire official Society or Trust name, exactly as it is written on your congregation's
Registration Certificate: Clarist Home, Manipur
Documents to Attache
1.) Trust and/or Society Registration Certificate
2.) Memorandum of Trust OR Memorandum of Association. Only attach the
page: “Aims and Objectives” of the organization
3.) 12A Certificate

I confirm that all of the wire transfer information entered in this section is correct. I understand
that $100 will be deducted from my grant amount if the funds are returned because of incorrect
banking information. If the Account Name is the name of an individual, I have provided her birth
date.

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CHECKS

Checks
Name of Payee:
Address:

Special Instructions:

I confirm that the payee and address information is correct.

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MONITOR & TRANSLATOR

Contact Information for the Local Monitor/Guarantor

First Name Stephen Seiminthang Last Name: Haokip
Congregation Name: Diocesan Social Service Society, Imphal, Manipur
Congregation Initials: DSSS
Email: stephenshaokip@yahoo.com Retype Email:

Monitor/Guarantor Agreement Form

Scan and/or save the completed document onto your computer. Then click on
the “Choose File” button to upload it to your application. DO NOT email this

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document as a separate attachment to HFS. If you need more instructions for
uploading documents, please click here.

English Translator (If any):

First Name Last Name:
Email: Retype Email:

I confirm that I have left this section blank because my request is for the U.S. I am also aware
that a representative from HFS may visit my site at any time.

OR

I confirm that I have completed this section correctly and have attached the Monitor/Guarantor
Agreement Form. I am also aware that a representative from HFS may visit my site at any time.
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CHECKLIST OF REQUIRED DOCUMENTS & CERTIFICATION

Checklist of Required Documents & Certification Page

1) Letter of Support
2) Monitor/Guarantor Agreement (I understand this is not necessary for requests in the U.S.)
3) Estimate/Price Quote (I understand this is for each individual item that costs $1,000 or
more.)
4) Supplemental Form (I understand that this is only if it applies to my request.)

Certification
1) As the Primary Sister Contact, I certify that all information in this application is accurate.

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2) I understand that my request will not be considered for funding if I have failed to provide
any of the required information.
3) I understand that submitting a grant application does NOT guarantee funding.
4) If my grant request is approved, I agree to complete the Grant Agreement upon receipt of
the award notification. I understand that I will not receive the funds until this is submitted.
5) I understand that the term of this grant is for ONE (1) FULL YEAR OR six (6) months for
Emergency Grants and that I may NOT submit another application for the same organization
within that period.
6) At the end of the 12-month grant period OR six (6) months for Emergency Grants, I agree to
submit the Grant Evaluation Report and the required Monitor/Guarantor Report if my
project is outside the U.S.
7) I understand that failure to submit the Grant Evaluation Report will disqualify me, and my
congregation, from receiving grants in the future.
8) I understand that the Board meets three (3) times a year to review applications and that I
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will be notified of the Board’s decision approximately five (5) months after the respective
submission deadline date.
9) I acknowledge the following deadlines and time frame for disbursement of funds.

Primary Sister Contact:

Date:
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