Constituency Project work planning tool for CMTs in Kaduna State (Constituency Project Nomination Form)
To be submitted to the Legislator representing the constituency (Senate and HoR) annually by Community Leaders/CMT Leads at the LGA level. Section 1, General Facility Data (must be completed)

Facility Name*

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Community name*

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Ward*

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LGA*

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State*

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Abuja
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
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Number of PWDs

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Name of Community Leader*

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Population of the community*

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Location of facility*

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Rural
Urban
Suburban
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Section 2: Nomination Section
Must be completed

Has the project been nominated previously? YES or NO*

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If yes, when?

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Year of Nomination*

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What project in your community do you want MDAs or legislators to include in the next State Budget/ZIP*

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Section 3: Other relevant facility data
Complete each question on each annual submission

Does your community have an adequate potable water supply?

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Does your community have adequate sanitation facilities?

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How many toilets does the school in your community have?

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How many classroom blocks does the school in your community have?

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Is there a fence in your school?

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Is the structure of the school accessible to PWDs (e.g ramps and wide doors)

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Is there an adequate potable water supply in your School?

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Are there teachers' quarters?

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Section 4: Details of Information Provider/Nominator
The form must be completed by the Community Leaders/ CMT Leads in the community

Phone of Women Leader (Traditional, Religious Political, WDC and SBMC etc)

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Phone number of the youth leader

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Phone number of the CoP Lead

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Phone number of the Head of Facilities

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Date of nomination

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Phone number of CoP rep

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Phone number of the Community Leader

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Name of CoP Lead

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Name of Head of Facilities

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Name of Youth Leader

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Name of Women Leader (Traditional, Religious Political, WDC and SBMC etc)

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Name of Community Leader (Traditional, Religious, Political, etc)

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