EUROMED HERITAGE II. Grant Application Form. European Commission. Budget Line B Dossier No. Name of the applicant:

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1 European Commission EUROMED HERITAGE II Grant Application Form Budget Line B Name of the applicant: Country (ies) of implementation: Dossier No (for internal use only)

2 I. THE PROJECT 1. D escr iption 1.1 T itle 1.2 Locati on C ountry or countri es, regi on, cities or tow ns 1.3 Amount r equested from the European C om mi ssi on EUR % of total project cost 1.4 Sum mar y Maximum 10 lines (include information on (a) the aim of the project, (b) the target groups and (c) the main activities). 1.5 Obj ectives Maximum 3 pages. Describe the objectives of the project. 1.6 Justi ficati on Maximum 5 pages. Provide the following information: (a) identification of perceived needs and constraints in the target countries (b) list of target groups with an estimate of the anticipated number of direct and indirect beneficiaries (c) reasons for the selection of the target groups and activities (d) relevance of the project to the target groups (e) relevance of the project to the objectives of the programme (f) relevance of the project to the priorities of the programme 2

3 1.7 D etai l ed descri pti on of acti vi ties Maximum 20 pages. Include the title and a detailed description of each activity. In this respect, the detailed description of activities must not be confused with the plan of action (see 1.9). 1.8 M ethodol ogy Maximum 4 pages. D etai l ed descri pti on of: (a) methods of impl ementati on (b) reasons for the proposed methodology (c) how the project intends to build on a previous project or previous activities (where applicable) (d) procedures for i nternal eval uation (e) l evel of i nvolvement and activi ty of other organisati ons (partners or others) in the project (f) reasons for the role of each partner (g) team proposed for implementati on of the project (by functi on: there i s no need to i ncl ude the names of individual s here) 1.9 D ur ati on and pl an of acti on The duration of the project will be months. Note: The indicative plan of action should not mention actual dates, but should start with month 1, month 2, etc. Applicants are advised to foresee a security margin in the proposed plan of action. The plan of action should not contain detailed descriptions of activities, but only their titles (please ensure that these match the titles listed in section 1.7). The plan of action for the first year of implementation must be sufficiently detailed to provide insight into the preparation and implementation of each activity. The plan of action for each of the following years (depending on project duration) may be more general and should only list the main activities foreseen for those years. 1 The plan of action must be provided in accordance with the following model: Year Activity Location (city, country) Implementing body Year 1 Month 1 Preparation of Activity 1 Leader Preparation of Activity 2 Partner 1 Month 2 Implementation of Activity 1 Preparation of Activity 3 Year 2 Month 1 Implementation of Activity 1 A more detailed plan of action for each of the following years will be required for the release of interim payments in accordance with Article 2(2) of the General and Administrative Provisions of the Grant Contract (see Annex E). 3

4 2. E xpected r esults 2.1 Estim ated i mpact on tar get gr oups Maximum 2 pages. Include information on: (a) how the project will improve the situation of the target groups (b) how the project will improve the managerial and technical capacities of the target groups or the partners (where applicable) 2.2 Publi cations and other outputs Maximum 1 page. Be specific and quantify outputs as much as possible. 2.3 M ul ti pli er effects Maximum 1 page. Describe the possibilities for replication and extension of project outcomes. 2.4 Sustainabi li ty Maximum 3 pages. Distinguish between the following aspects of sustainability: (a) financial sustainability (How will the activities be financed after the EC funding ends?) (b) institutional sustainability (Will structures allowing the activities to continue be in place at the end of the present project? Will there be local ownership of project outcomes?) (c) sustainability at the policy level (where applicable) (What will be the structural impact of the project e.g. will it lead to improved legislation, codes of conduct, methods, etc?) 4

5 3. B udget for the project Provide a budget for the total duration of the project and for the first 12 months of the project. See Guidelines for Applicants, section 2.5 (payments) for further information. Note: The budget must be provided in accordance with Annex B (Excel file). The budget format is contained in Worksheet 1 (3. Budget). 4. E xpected sour ces of funding Provide information on the expected sources of funding for the project. Note: this information must be provided in accordance with Annex B (Excel file). The format is contained in Worksheet 2 (4. Sources of Funding). To switch between Excel Worksheets, click the tab at the bottom of the screen. 5

6 II. THE APPLICANT 1. Identity 1.1 Consortium Name: 1.2 Consortium Representative Ful l l egal name ( bu sin ess nam e) : A cronym (w here appli cable): Legal status: V AT regi stration number ( wh er e a pp licab le) : Offici al address: P ostal address: C ontact person: Tel ephone n : Fax n : E -mai l address: W ebsi te: 2. B ank details The bank must be i n the country i n w hi ch the appli cant i s registered. A ccount name: B ank account no: B ank code: S WIFT code: B ank name: B ank address: N ame(s) of si gnatory(i es): P ositi on(s) of signatory(i es): 6

7 3. D escr iption of the applicant (maxi mum 3 pages) 3.1 W hen w as your or gani sation founded and w hen di d it star t i ts acti vities? 3.2. W hat are the mai n activiti es of your organi sation at present? 3.3. List of the m anagement board / comm i ttee of your or gani sation. Name Profession Gender Function Years on the board F / M F / M 4. Capacity to m anage and im plement pr ojects 4.1. Exper i ence wi th si mi l ar pr oj ects Maximum 1 page per project. Detailed description of projects managed by your organisation and by each partner over the past five years in the fields covered by this programme, identifying for each project: (a) the object and location of each project (b) the results of the project (c) your organisation s (your partner organisation s) role (leader, partner) and level of involvement in the project (d) the project cost (e) the donors of the project (name, address and , telephone number, amount contributed) 4.2 R esour ces Maximum 3 pages. Detailed description of the various resources at the disposal of your organisation including: (a) the annual income over the past three years, menti oni ng where appl icabl e for each year the names of the mai n financial contri butors and the proporti ons of annual i ncome contri buted by them (b) the number of full -ti me and part-ti me staff by category (e.g. number of proj ect managers, accountants, etc). (c) equipment and offi ces (d) other relevant resources 7

8 5. Other applications submitted to European Institutions, the Eur opean D evelopm ent Fund (E DF) or EU Member States 5.1 Grants, contr acts or loans obtained duri ng the l ast thr ee years fr om European Insti tutions, the ED F or EU Mem ber States Title of operation EC budget line, EDF or other source Amount (EUR) Date of award 5.2 Grant appl i cati ons subm itted ( or due to be submi tted) to Eur opean Insti tuti ons, the ED F or EU Member States i n the cur r ent year: Title of project EC budget line, EDF or other source Amount (EUR) 8

9 III. PARTNERS OF THE APPLICANT PARTICIPATING IN THE PROJECT 1. Descr iption of the par tners This section must be completed for each partner organisation. You may duplicate this table as necessary to create entries for more partners. Ful l l egal name ( bu sin ess nam e) N ational ity Legal status Offici al address C ontact person Tel ephone n Fax n E -mai l address N umber of staff (permanent and non-permanent) H istory of co-operati on w i th the appl icant R ol e and i nvolvement in preparing the proposed project R ol e and i nvolvement in i mplementi ng the proposed project P artner 1 P artner 2 Im portant: This appl icati on form must be accompani ed by a si gned and dated partnership statement from the mai n appli cant and every partner in accordance with the model provi ded on the next page. R epresentatives and par tners m ust sign a Memor andum of U nder standing describing their roles and r esponsibilities in the pr oject (see Guidelines, sections and 2.2.1). The MoU m ust be annexed to this pr oject pr oposal. 9

10 IV. DECLARATION BY THE APPLICANT I, the undersigned, being the person responsible in the applicant organisation for the project, certify that the information given in this application is correct. Name: Position: Signature: Date and Place: C hecklist Before sending your proposal, please check that your application is complete: The application form the proposal is complete and filled out in accordance with the application form one original and seven copies of all documents the proposal is typed and is in English or French the applicant and all partners are eligible according to the Guidelines the budget and the expected sources of funding are presented in the format of the application form (Annex B) in the budget the Commission s contribution is identified and is maximum 80% of total eligible project costs in the budget the administration costs are 7% or less of eligible project costs in the budget the contingencies are no more than 5% of eligible costs the declaration by the applicant (Section IV) is signed the logical framework for the project and, where applicable, sub-projects, is complete (Annex C) Annexes the statutes or articles of association of the applicant and of all the partners are included the most recent annual reports and accounts of the applicant and the partners are included the most recent accounts of the applicant are included the Memorandum of Understanding is included and has been signed by all partners an organisational chart has been annexed to the application form the CVs of the core project managers are included 10

11 A nnex B Budget N ote: Thi s document i s i n Microsoft E xcel format and i s contai ned i n a separate fi le. A nnex C Logical fr amewor k N ote: Thi s document i s i n Microsoft E xcel format and i s contai ned i n a separate fi le. A nnex D Daily allowance rates (per diems) as of 1 January 2000 Notes: Per diems include all costs: hotels, food and transport within the city. The latest per diem can be found on: A nnex E Standard contract Note: The standard contract is section 4 on: 11