Programmefundedbythe EUROPEAN UNION

CONTRACTING AUTHORITY Romanian Ministry of Regional Development and Tourism

Joint Operational Programme Romania-Ukraine-Republic of Moldova 2007-2013

GRANT APPLICATION FORM

Reference: 2nd call for proposals, Restricted call for proposals Deadline for submission of Concept Notes 30th of January 2012 (first step)
For economical and ecological reasons, we strongly recommend that you submit your files on paper-based materials (no plastic folder or divider). We also suggest you use double-sided print-outs as much as possible.

Title of the action: Number and title of the priority Priority 3 People-to People cooperation

[Please choose and delete those which are not applicable:]

Number and title of the measure

3.1 Local and regional governance, support to civil society and local communities 3.2 Educational, social and cultural exchanges

Location(s) of the action: Name of the applicant

[specify country(ies), county(ies)/oblast, district(s), town(s)/locality(ies) that will benefit from the Action]

[in English and in the national language]

Nationality of the applicant1

Dossier No
(for official use only)
1

The statutes must make it possible to ascertain that the organisation was set up by an act governed by the national law of the country concerned. In this respect, any legal entity whose statutes have been established in another country cannot be considered an eligible local organisation. The international organisations does not have to fulfil the nationality requirements (see also sections 2.1.2.1. and 2.1.2.2 of the Guidelines for applicants) Page 1 of 38

2010 Grant Application Form for Priority 3 People to people cooperation

Page 2 of 38

Ongoing contract / Legal Entity file number (if available)2 Legal status3 Partner(s)4
[Name in English and in the national language, Legal status, Nationality]

CONTACT DETAILS OF THE APPLICANT FOR THE PURPOSE OF THIS ACTION:

Postal address:

Telephone number:
(fix and mobile) [Country code + city code + number]

Fax number:
[Country code + city code + number]

Contact person for this action: Contact persons email address: Website of the organization

Any changes in the addresses, phone numbers, fax numbers and in particular e-mail, must be notified in writing to the Joint Technical Secretariat. The Contracting Authority or the Joint Technical Secretariat will not be held responsible in case it cannot contact the applicant.

2 3 4

If an applicant has already signed a contract with the European Commission and/or has been informed of the Legal Entity file number; if neither of this apply, indicate N/A Check carefully Section 2.1.1 Eligibility of applicants: who may apply? of the Guidelines for grant applicants. E.g. non profit making, governmental body, public institution, public administration, public bodies, international organisation Add as many rows as partners Page 2 of 38

2010 Grant Application Form for Priority 3 People to people cooperation

Page 3 of 38

TABLE OF CONTENTS

PART A. CONCEPT NOTE...........................................................................................5

1. INSTRUCTIONS FOR DRAFTING OF THE CONCEPT NOTE................................................5
1.1 SUMMARY OF THE ACTION (MAX. 1 PAGE)...............................................................................................5 1.2 RELEVANCE AND THE CROSS BORDER IMPACT OF THE ACTION (MAX. 5 PAGES).........................6 1.3 DESCRIPTION OF THE ACTION (MAX. 4 PAGE) .........................................................................................7

2. CHECKLIST FOR CONCEPT NOTE.............................................................................................8 3. DECLARATION BY THE APPLICANT FOR CONCEPT NOTE..............................................9 4. PARTNERSHIP STATEMENT .....................................................................................................10 5. ASSESSMENT GRID FOR THE CONCEPT NOTE...............................................................................................11

PART B. FULL APPLICATION FORM.......................................................................12

1. GENERAL INFORMATION........................................................................................................12 2. THE ACTION..................................................................................................................................13
2.1 BUDGET OF THE ACTION, AMOUNT REQUESTED FROM THE CONTRACTING AUTHORITY AND OTHER EXPECTED SOURCES OF FUNDING....................................................................................13 2.2 DESCRIPTION OF THE ACTION.............................................................................................................14 2.3 OTHER FUNDS ADDRESSED WITH THIS PROJECT .........................................................................21

6. THE APPLICANT............................................................................................................................22
3.1 IDENTITY....................................................................................................................................................22 3.2 PROFILE......................................................................................................................................................23 3.3 CAPACITY TO MANAGE AND IMPLEMENT ACTIONS.....................................................................24 3.4 LIST OF THE MANAGEMENT BOARD / COMMITTEE OF YOUR ORGANIZATION ...................26

4. PARTNERS OF THE APPLICANT PARTICIPATING IN THE ACTION............................27

4.1 IDENTITY....................................................................................................................................................27 4.2 CAPACITY TO MANAGE AND IMPLEMENT ACTIONS (1 PAGE PER ACTION, FOR ALL THE PROJECT PARTNERS)..............................................................................................................................................................28 4.4 PARTNERSHIP STATEMENT...................................................................................................................30

5. ASSOCIATES OF THE APPLICANT PARTICIPATING IN THE ACTION................................................................................................32 6. CHECKLIST FOR THE FULL APPLICATION FORM..................................................................................33 7. DECLARATION BY THE APPLICANT......................................................................................35 8. INDICATORS .................................................................................................................................................................37 9. ASSESSMENT GRID OF THE FULL APPLICATION FORM .................................................................................................................................................................37

Page 3 of 38

2010 Grant Application Form for Priority 3 People to people cooperation

Page 4 of 38

Page 4 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 5 of 38

PART A.

CONCEPT NOTE

1. INSTRUCTIONS FOR DRAFTING OF THE CONCEPT NOTE

There is no specific template for the Concept Note but the applicant has to ensure that the text of its concept note:

Does not exceed 10 full pages (A4 size) of Arial 10 characters with 2 cm margins;

Responds, in the same sequence, to the headings listed below. It is expected that the size of each section will reflect the relative importance of each heading (ref max scores in the Evaluation Grid and in the Guidelines). The evaluation will be carried out in accordance with the evaluation grid and it will be based solely on the information provided by the applicant in the concept note. Is drafted as clearly as possible to facilitate its assessment.

Please note that, when assessing the Concept Note, the Evaluation Committee will only consider the first 10 pages. Moreover, all the information requested by the published instructions for drafting of the Concept Note must be provided. Consequently, the non-observance of the maximum number of pages requirement may conduct to the rejection of the application.

1.1

SUMMARY OF THE ACTION (max. 1 page)

Please complete the table below, which should not exceed 1 page. Title of the action Aim of the priority addressed by the action Location(s) of the action Total duration of the action Amount of requested EU contribution Objectives of the action To promote greater interaction between people and communities living in the border areas
[country(ies), county(ies)/oblast(s), district(s)/locality(ies) that will benefit from the action]

[ ] months [] EUR Overall objective(s): Specific objective(s):

Target group(s)5

Target groups are the groups/entities who will be directly positively affected by the project at the Project Purpose level.

Page 5 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 6 of 38

Final beneficiaries6 Estimated results7 Mactivities

1.2

RELEVANCE AND THE CROSS BORDER IMPACT OF THE ACTION (max. 5 pages)

1.2.1 Relevance to the objectives/sectors/themes/priority of the call for proposals

Please provide all the following information: a) Describe the relevance of the action to the objective(s) and priority (ies) of the Call for proposals. b) Describe the relevance of the action to the specific themes/sectors/areas and any other specific requirements indicated in the guidelines of the call, such as cross border partnership, local ownership, cross border impact etc. c) Describe which particular expected results mentioned in the guidelines of the call (Annex L Priority indicators) will be addressed. d) Indicate how the project pursues to create basis for effective cross border cooperation by putting into practice at least two of the following cross border cooperation criteria: joint project development, joint project implementation, joint staffing, and joint financing. e) Please explain what are the benefits foreseen at the level of the cross border area, what changes they will support and how they will contribute to the projects specific objective(s). In exceptional cases when an organisation located outside the Programme area is involved as a partner in the project , please justify the necessity of including it in the project

1.2.2 Relevance to the particular needs and constraints of the target country/countries, region(s) and/or relevant sectors (including synergy with other EU initiatives and avoidance of duplication)
Please provide all the following information: a) Identify clearly the specific pre-project situation in the target country/countries, region(s) and/or sectors (include quantified data analysis where possible and make reference to official data). b) Provide a detailed analysis of the problems to be addressed by the action and how they are interrelated at all levels. c) Where the action is a continuation of a previous action clearly indicate how the proposed action is intended to build on the activities/results of this previous action; refer to main conclusions and recommendations of evaluations that might have been carried out. d) Where the action is part of a larger programme, clearly explain how it fits or is coordinated with this programme or any other planned project. Specify the potential synergies with other initiatives, in particular from the European Commission. I e) In addressing the points above, refer to any significant strategies and action plans undertaken at national, regional and/or local level relevant for the action and describe how the action will relate to such plans. Provide reliable sources of information and if available, provide web links where the documents may be consulted. Where the project innovates and is not framed in a national/regional strategy or action plan, indicate the added value of the project from the perspective of programme objectives and complementarity with the national and regional strategies.
6 7

Final beneficiaries are those who will benefit from the project in the long term at the level of the society or sector at large. Results are the tangible products/ services delivered as a consequence of implementing a project.

Page 6 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 7 of 38

1.2.3 Describe and define the target groups and final beneficiaries, their needs and constraints and how the action will address these needs
Please provide all the following information, indicating reliable sources: a) Include a description of each target groups and final beneficiaries (quantify where possible), including criteria for their selection. b) Identify needs and constraints of each target groups and final beneficiaries. c) Demonstrate the relevance of the proposal to the needs and constraints of the target groups and final beneficiaries. d) Explain any participatory process ensuring participation of the target groups and final beneficiaries.

1.2.4 Particular added-value elements

Indicate how the proposal contribute to promotion or consolidation of public/private partnerships, innovation and best practices, or other cross-cutting issues such as environmental issues, promotion of gender equality and equal opportunities, needs of disabled people, rights of minorities and rights of indigenous people.

1.3 DESCRIPTION OF THE ACTION (max. 4 page)

Please provide all the following information: a) Background to the preparation of the action. b) Describe the objectives of the action. (Elaborate here on the objectives mentioned in the table in section 1.1 above.) c) Describe the key stakeholders groups, their attitudes towards the action and any consultation undertaken with them. d) Provide brief information on the type of activities foreseen and specify related outputs and results, including a description of linkages/relationships between activity clusters. e) Indicate a broad timeframe for the action and describe any specific factor that has been taken into account. f) In exceptional cases, when projects can take place partially in regions other than those defined by the programme area, please explain why is this necessary for achieving projects objectives

Page 7 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 8 of 38

Joint Operational Programme Romania-Ukraine-Republic of Moldova 2007-2013 Priority 3 People to people cooperation 2nd Call for proposals
ADMINISTRATIVE DATA Name of the applicant Country and date of registration Legal Entity File number Legal status Partner 1 Partner 2 [Add as many rows as partners]
9 8

2. CHECKLIST FOR CONCEPT NOTE

[To be filled in by the applicant]

[in English and in the national language]

Name [in English and in the national language]: Country of registration: Legal status: Name [in English and in the national language]: Country of registration: Legal status:

Before sending your Concept Note, please check that each of the following points is complete and respects the following criteria Title of the Proposal: PART 1 (ADMINISTRATIVE) 1. The instructions for concept note, published for this call for proposals, have been followed: max. 10 full pages, (A4 size) of Arial 10 characters with 2 cm margins? 2. The Declaration by the applicant has been filled in, signed, stamped, dated
8 9

To be filled in by the applicant YES NO

If the applicant has already signed a contract with the European Commission E.g. non profit making, governmental body, international organization, public body, etc.

Page 8 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 9 of 38

and is enclosed? 3. The partnership statement(s) signed stamped and dated by each partner is /are enclosed? 4. The proposal is typed and is in English? 5. One original and 4 copies are included? 6. An electronic version of the concept note (CD-ROM) is enclosed? 7. An electronic copy of the national/strategies, action plans, relevant for the project is enclosed, or a web link was provided? PART 2 (ELIGIBILITY) 8. The applicant and partner(s) organisations are located in the programme area, or participation of a partner located outside the programme area is motivated in the concept note? 9. The entire action will be implemented in the eligible area of the programme, or When part of the action will take place in regions other than those defined by the programme area, a duly justifications was provided by the applicant in the concept note ? 10. The duration of the action is between 6 months (the minimum allowed by this Call) and 18 months (the maximum allowed by this Call)? 11. The requested EU contribution is between 30,000 EUR (the minimum allowed by this Call) and 150,000 EUR (the maximum) allowed by this Call)? 12. The present Checklist and the Declaration by the applicant are filled in and sent with the Concept Note?

3. DECLARATION BY THE APPLICANT FOR CONCEPT NOTE

The applicant, represented by the undersigned, being authorised signatory for the applicant, and in the context of the present application, representing any partners in the proposed action, hereby declares that a) The applicant has the sources of financing and professional competence and qualifications specified in section 2 of the Guidelines for Applicants;

b) The applicant undertakes to comply with the obligations foreseen in the partnership statement of the grant application form and with the principles of good partnership practice;

c) The applicant is directly responsible for the preparation, management and implementation of the action with its partners, and is not acting as an intermediary; d) The applicant and its partners are not in any of the situations excluding them from participating in contracts which are listed in Section 2.3.3 of the Practical Guide to contract procedures for EU external actions (available from the following Internet address) http://ec.europa.eu/europeaid/work/procedures/implementation/index_en.htm Furthermore, it is recognized and accepted that if we participate in spite of being in any of these situations, we may be excluded from other procedures in accordance with section 2.3.5 of the Practical Guide;

Page 9 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 10 of 38

e) The applicant and each partner are in a position to deliver immediately, upon request, the supporting documents stipulated under section 2.4 of the Guidelines for Applicants;

f)

The applicant and each partner are eligible in accordance with the criteria set out under sections 2.1.1 and 2.1.2 of the Guidelines for Applicants;

g) If recommended to be awarded a grant, the applicant accepts the contractual conditions as

laid down in the Standard Contract annexed to the Guidelines for applicants (annex IIA);

h) The applicant and its partners are aware that, for the purpose of safeguarding the financial interests of the European Union, their personal data may be transferred to internal audit services, to the European Court of Auditors, to the Financial Irregularities Panel or to the European Anti-Fraud Office. Signed on behalf of the applicant Name Signature and stamp Position Date

4. PARTNERSHIP STATEMENT

10

I hereby certify that the [insert the name of the organization that fills in the partnership statement in English and in national language] commits itself to the operation. I confirm that no expenditure related to the activities foreseen to be implemented in the above mentioned project by [insert the name of the organization that fills in the partnership statement in English and in national language] has been funded by any other EU programme.

10

To be multiplied and filled in by each project partner. This parnership statement must only be filled in by project partners.It is not necessary for the Applicant to sign a partnership statement.

Page 10 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 11 of 38

I have read and approved the contents of the concept note submitted to the Joint Managing Authority (the Ministry of Regional Development and Tourism from Romania). I undertake to comply with the principles of good partnership practice. Signed on behalf of the Partner [insert the name of the organization that fills in the partnership statement in English and in national language]: Name : Organisation: Position: Signature and stamp: Date and place:
11

5. ASSESSMENT GRID FOR THE CONCEPT NOTE

(For the use of the Contracting Authority only)

YES 1. The submission deadline has been respected? 1. The Checklist has been duly completed? The administrative verification has been conducted by: Date: DECISION 1: The Committee has decided to evaluate the Concept Note after having
11

NO

Legal representative of the organization

Page 11 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 12 of 38

passed the Administrative Check. The evaluation of the Concept Note has been conducted by: Date: DECISION 2: The Committee has decided to recommend evaluating the full application form.

PART B.

FULL APPLICATION FORM

Only to be completed by the applicants who receive an invitation to submit a full application (at the time of the invitation)
For economical and ecological reasons, we strongly recommend that you submit your files on paper-based materials (no plastic folder or divider). We also suggest you use double-sided print-outs as much as possible.

1.

GENERAL INFORMATION
Joint Operational Programme Romania-Ukraine-the Republic of

Reference of the Call for

Page 12 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 13 of 38

proposals Title of the Call for proposals Name of the applicant N of the proposal Title of the action
12

Moldova 2007-2013 the 2nd Call for proposals [in English and in its national language]

13

Location of the action N and title of the Priority N and title of the Measure

[country (ies) / region(s)/ localities that will benefit from the action] Priority 3 People-to-people cooperation
[Please choose and delete those which are not applicable:] 3.1 Local and regional governance, support to civil society and local communities 3.2 Educational, social and cultural exchanges

2.
2.1

THE ACTION

14

BUDGET OF THE ACTION, AMOUNT REQUESTED FROM THE CONTRACTING AUTHORITY AND OTHER EXPECTED SOURCES OF FUNDING

Fill in Annex B to the Guidelines for applicants to provide information on: The budget of the action (worksheet 1), for the total duration of the action and for its first 12 months, at project level and for each project partner, including the applicant AND, Justification on the budget (worksheet 2), for the total duration of the action AND, Amount requested from the Contracting Authority and other expected sources of funding for the action for the total duration (worksheet 3).

For further information see the Guidelines for grant applicants (sections 1.4, 2.1.4 and 2.2.5). Please note that the cost of the action and the contribution requested from the Contracting Authority have to be expressed in EUR, using two decimals.. Please mention here the contributions in kind to be provided (please specify), if any (maximum 1 page). However, please note that contributions in kind are not considered actual expenditure and are not eligible costs. Contributions in kind may not be treated as co-financing by the applicant.

12

The proposal number as allocated by the Contracting Authority and notified to the applicant at the time of the Concept Note opening and administrative check. 13 As notified by the evaluation committee at the end of the 1st step. 14 The evaluation committee will refer to information already provided in the Concept Note as regards objectives and relevance of the action.

Page 13 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 14 of 38

The budget includes the budget lines for the whole actions well as the division of funds between the partners. Please fill in Annex B (worksheets 1, 2 and 3) for the total duration of the action and for its first 12 months.

2.2

DESCRIPTION OF THE ACTION

2.2.1 Description of the action and its effectiveness (max 14 pages)

Provide a description of the proposed action, including all the information requested below: Making reference to the overall objective(s) and specific objective(s), outputs and results described in the concept note, elaborate on specific expected results indicating how the action will improve the situation of the target groups and final beneficiaries as well as the technical and management capacities of target groups and/or any local partners. Indicate in particular foreseen publications. Making reference to the overall objective(s) and specific objective(s), outputs and results described in the concept note, identify and describe in detail each work package to be undertaken to produce results, justifying the choice of the activities and specifying the role of each partner (and associates, or contractors) in the activities. In this respect, the detailed description of activities must not repeat the action plan (to be provided in section 2.2.3 below) but demonstrate coherence and consistency in the project design. In order to facilitate the management, Applicants are asked to divide the joint Action into maximum 5 thematically diversified components, Groups of Activities. A Group of Activities (GAs) is interlinked thematically in the project. Groups of activities should be broken down into activities, in order to make them sufficiently simple to be organized and easy to manage, but please make sure that you do not get into too much detail: the breakdown should stop as soon as the planner has sufficient detail to estimate the time and resources required, and the person responsible for actually doing the work has sufficient instructions on what has to be done. Make sure that you do not omit essential activities and/or tasks, like project management and communication/publicity activities. The description under GAs must be as precise as possible to deliver a clear picture of the planned activities and their outputs and results, to allow for proper assessment of the relevance and necessity of the Action, as well as its cost-effectiveness and cross-border impact. The first GA must always contain information about the overall project management, coordination and communication (internal and external communication) in the context of the action, while a separate GA should deal with the visibility actions related to the action. The remaining GAs (up to 3 thematic GAs) will be defined by the Action. First, the Action must define the titles of the GAs, describe their aim and purpose (justification), and then provide the description of the GAs as defined below in the GA tables.

Page 14 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 15 of 38

GROUP OF ACTIVITIES 1: Aim and purpose of the GA (general description of the GA)

Project management, coordination and communication To ensure proper project implementation

15

To ensure that the project will achieve the expected results and objectives, while complying with the contract provisions and the requirements of the programme. Organisation of project team meetings months 1-18 To ensure proper communication and coordination between the members of the project implementation team and between project partners . applicant partner 1 and 2 Target group(s) NA NA NA NA NA 2 PT meetings 1 PT meeting 2 PT meetings 1 PT meeting 2 PT meeting Outputs Results a well managed project a well managed project a well managed project a well managed project a well managed project

Activity 1.1 Total duration of the activity Aim(s) and short description of the activity Responsible partner Involved partners Evolution per quarter months 1-4 months 5-8 months 9-12 months 13-16 months 17-18 Activity 1.2 Total duration of the activity Aim(s) and short description of the activity Responsible partner Involved partners Evolution per quarter
15

Target group(s)

Outputs

Results

Please note that the texts highlighted in gray colour are provided only as examples and remember to delete them in the final version of the Grant Application Form. The information must be consistent with the contents of the Logical Framework and of the Budget

Page 15 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 16 of 38

months 1-4 months 5-8 months 9-12 months 13 - 16 months 17 - 18

GROUP OF ACTIVITIES 2 Activity 2.1

16

Total duration of the activity Aim(s) and short description of the activity Responsible partner Involved partners Evolution per quarter months 1-4 months 5-8 months 9-12 months 13 - 16 months 17 - 18 Activity 2.2 Total duration of the activity Aim(s) and short description of the activity
16

Target group(s)

Outputs

Results

To be multiplied for the necessary number of Group of activities

Page 16 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 17 of 38

Responsible partner Involved partners Evolution per quarter months 1-4 months 5-8 months 9-12 months 13 - 16 months 17 - 18 Target group(s) Outputs Results

Page 17 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 18 of 38

2.2.2 Methodology (max 4 pages)

Describe in detail:

a) the methods of implementation and reasons for the proposed methodology (including a
justification for the project duration);

b) where the action is the prolongation of a previous action, explain how the action is intended

to build on the results of this previous action. Give the main conclusions and recommendations of evaluations that might have been carried out;

c) where the action is part of a larger programme, explain how it fits or is coordinated with

this programme or any other possibly planned project. Please specify the potential synergies with other initiatives, in particular from the European Union;

d) the procedures for follow up and internal/external evaluation; e) the role and participation in the action of the various actors and stakeholders (partner(s),
target groups, local authorities, etc.), and the reasons for which their roles for the project;

f) the organisational structure of the team proposed for the implementation of the action (by
function: there is no need to include the names of individuals)

Please fill in the table below and give information about the structure of the project team (e.g. project coordinator, financial manager etc.) and indicate the degree of involvement of each partner.

Project team17
Function Project manager Financial manager 1 Project coordinator Financial manager 2 Full time x x x x Part time Partner Applicant Applicant Partner 1 Partner 1

If the case may be, please describe other relevant human resources that might also contribute to implementation of the project (e.g. volunteers, associated organizations, networks)

partners Please give details on:

g) the main means proposed for the implementation of the action by the applicant and its

17

Please note that the texts highlighted in gray color are provided only as examples and remember to delete them in the final version of the Grant Application Form. The information must be consistent with the contents of the Logical Framework and of the Budget

Page 18 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 19 of 38

q offices, equipment, materials and supplies to be provided by the applicant and its
partners from their own resources
E.g. Applicant office room (20 sqm) fully operational, 1 PC with internet connection to be used by the project team, 1 copy machine, 1 car to be used for the project Partner 1 office room (50 sqm), 2 PCs to be used by the project team Partner 2 2 photo cameras to be used for the project

q offices, equipment, materials and supplies to be purchased or rented for the

project, during its implementation
E.g. Applicant 1 location to be rented for training activities (GA 2), 2 PCs, 2 copy machines Partner 1 1 car to be rented for the project (documentary activities) Partner 2 office room (15 sqm) to be rented for the project, 3 PCs

h) the attitudes of all stakeholders towards the action in general and the project activities in
particular

i) the justification for developing part of the activities of the project outside the programme area
(if the case)

j) the planned activities in order to ensure the visibility of the action and the EU funding. 2.2.3 Duration and indicative action plan for implementing the action (max 4 pages) The duration of the action will be [X] months.
Applicants should not indicate a specific startup date for the implementation of the action but simply show "month 1", "month 2", etc. Applicants are recommended to base the estimated duration for each activity and total period on the most probable duration and not on the shortest possible duration by taking into consideration all relevant factors that may affect the implementation timetable. The activities stated in the action plan should correspond to the activities described in section 2.2.1. The implementing body shall be either the applicant or any of the partners, associates or subcontractors. Any months or interim periods without activities must be included in the action plan and count toward the calculation of the total estimated duration of the action. The action plan for the first 12 months of implementation should be sufficiently detailed to give an overview of the preparation and implementation of each activity. The action plan for each of the subsequent years may be more general and should only list the main activities foreseen for those years. To this end, it shall be divided into six-month interim periods (NB: A more detailed action plan for each subsequent year will have to be submitted before receipt of new pre-financing payments, pursuant to Article 2.1 of the General Conditions of the grant contract). The action plan will be drawn up using the following format:

Page 19 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 20 of 38

YEAR 1 Semester 1 Activity/Mon th GA example 1

18

Semester 2 5 6 7 8 9 10 11 12

Implementing body

Preparation Activity 1.1 (title) Execution Activity 1.1 (title) Preparation Activity 1.2 (title) Etc.

YEAR 2 Semester 1 Semester 2 Implementing body 11 12

Activity/Mon ths GA 1 GA 2 GA 3 Etc.

10

2.2.4 Sustainability (max 3 pages)

Provide all the information requested below:

a) Describe the expected impact, especially the cross border impact of the action
with quantified data where possible, at technical, economic, social and policy levels (will it lead to improved legislation, codes of conduct, methods, etc.?).

18

Please note that the cells highlighted in gray color are provided only as examples and remember to delete them in the final version of the Grant Application Form. The information must be consistent with the contents of the Logical Framework and of the Budget

Page 20 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 21 of 38

b) Describe a dissemination plan and the possibilities for replication and extension of
the action outcomes (multiplier effects), clearly indicating any foreseen dissemination channel.

c) Provide a detailed risk analysis and contingency plan.

This should include at least a list of risks associated with each group of activity proposed, accompanied by relevant mitigation measures. A good risk analysis would include a range of risk types including physical, environmental, political, economic and social risks.

d) Describe the main preconditions and assumptions during and after the implementation phase.

e) Explain how sustainability will be secured after completion of the action.

This may include aspects of necessary follow-up activities, built-in strategies, ownership, communication plan etc. In doing so, please make a distinction between the following dimensions of sustainability:

Financial sustainability (financing of follow-up activities, sources of revenue for covering all future operating and maintenance costs, etc.); Institutional sustainability (including structures that would allow the results to continue to be in place after the end of the action, capacity building, agreements and "ownership" of action outcomes); Policy level sustainability, where applicable (including what structural impact of the action have - e.g. will it lead to improved legislation, codes of conduct, methods, etc.); Environmental sustainability (what impact will the action have on the environment have conditions put in place to avoid negative effects on natural resources on which the action depends and on the broader natural environment).

2.2.5 Logical framework

Please fill in Annex C to the Guidelines for applicants, if the requested grant is over EUR 100,000). For further explanations about how to fill in the Logical Framework, you can consult Project Cycle Management available at
http://ec.europa.eu/europeaid/multimedia/publications/publications/manuals-tools/t101_en.htm

2.3

OTHER FUNDS ADDRESSED WITH THIS PROJECT

NO

Has the project applied to other funds for support to all or some of the activities proposed under this call (e.g. national funds, EU funds: Phare CBC, other ENPI programmes, Structural Funds)? If YES, please specify within which programme and provide details of its scope and of its timeframe.

YES

Page 21 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 22 of 38

6. THE APPLICANT
Name of the organisation [in English and in the national language]

3.1

IDENTITY

The applicants contact details for the purpose of this action Legal Entity File number Abbreviation Registration number (or equivalent) Date of Registration Place of Registration Official address of Registration Country of Registration County (Oblast) District Town/ Village/ Commune E-mail address of the organisation Telephone number: [Country code + city code + number] Fax number: [Country code + city code + number] Website of the organisation Information under this point need only be given in cases where there have been modifications or additions as compared to the information given in the Concept Note form. Any changes in the addresses, phone numbers, fax numbers and in particular e-mail, must be notified in writing to the Joint Technical Secretariat. The Contracting Authority or the Joint Technical Secretariat will not be held responsible in case it cannot contact the applicant.
19

19

If the applicant has already signed a contract with the European Commission Page 22 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 23 of 38

3.2

PROFILE

Legal status Profit-Making Yes No NGO Yes No Value based20 Political Religious Humanistic Neutral Is your organisation linked with another entity? Yes, parent entity: (please specify its EuropeAid ID:) Yes, controlled entity(ies) Yes, family organization / network entity21 No, independent

3.2.1. Category
Category22 Public Administration International Organisation Local Authority Implementation Agency University/Education Research Institute Foundation Association Media Network/Federation Professional and/or Industrial Organisation Trade Union Cultural Organisation Other (please specify)

3.2.2 Sector (s) Please specify the Sector to which your organisation belongs, as defined in its statutes (or equivalent document).

20

Please choose only one set of values. 21 E.g. confederation / federation /alliance
22

Please specify the Category to which your organisation belongs (ONE CHOICE ONLY);

Page 23 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 24 of 38

3.2.3.Target group(s)
All Children (less than 18 years old) Young people Community Based Organisation(s) Consumers Disabled Drug consumers Educational organisations (school, universities) Elderly people Illness affected people Local authorities Migrants Non-Governmental Organisations Professional category Research organisations/Researchers SME Students Victims of catastrophes Women Other (please specify): .. 3.3 CAPACITY TO MANAGE AND IMPLEMENT ACTIONS

3.3.1 Experience in donor funded projects in the same or similar sector(s)

Please provide a detailed description of actions managed by your organization over the past seven years and indicate the role of your organization (maximum 1 page per action). This information will be used to assess whether you have sufficient experience of managing actions of a comparable scale to the one for which the present grant is being requested. Project title: Sector: Location of the action Cost of the Action (EUR) Please indicate the role of your organization in the project: Lead partner or partner Amount contributed [EUR] and donor24 Duration
(from dd/mm/yyyy to dd/mm/yyyy)
23

Objectives and results of the action

3.3.2 Financial and human resources of the applicants organization

23 24

Please insert as many tables as necessary: one for each project.

If the donor is the European Union or an EU Member State, please specify the EU budget line, EDF or EU Member State.

Page 24 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 25 of 38

3.3.2.1

Financial data

Please provide the following information, if applicable, on the basis of the profit and loss account and balance sheet of your organisation, amounts in thousands Euro 25 .
Year N26 N-1 N-2 Turnover or equivalent Net earnings or equivalent Total balance sheet or budget Shareholder s equity or equivalent Medium and long-term debt Short-term debt (< 1 year)

3.3.2.2

Financing Source(s)

Please tick the source(s) of the revenues of your organisation and specify the additional information requested.
Year N N N N N N N N N N-1 N-1 N-1 N-1 N-1 N-1 N-1 Source EU Commission Member States Public Bodies Third Countries Public Bodies United Nations Other international Organisation(s) Private Sector Members fees Other (please specify) Total EU Commission Member States Public Bodies Third Countries Public Bodies United Nations Other international Organization(s) Private Sector Members fees 100% Percentage (total for a given year must be equal to 100%) Number of fee-paying members (only for source = Member's fees) N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

25

If your project will be selected, these financial data will be checked and they should correspond to the amounts indicated here. 26 N = previous financial year

Page 25 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 26 of 38

Year N-1 N-1 N-2 N-2 N-2 N-2 N-2 N-2 N-2 N-2 N-2

Source Other (please specify) Total EU Commission Member States Public Bodies Third Countries Public Bodies United Nations Other international Organization(s) Private Sector Members fees Other (please specify) Total

Percentage (total for a given year must be equal to 100%)

Number of fee-paying members (only for source = Member's fees) N/A

100%

N/A N/A N/A N/A N/A N/A N/A N/A N/A

100%

N/A

3.3.2.3

Number of staff

Please tick one option for each type of staff. Type of staff Full time Number of < 10 > 10 and > 50 and > 100 N/A < 10 > 10 and > 50 and > 100 N/A staff < 50 < 100

Part time

< 50 < 100

3.4

LIST OF THE MANAGEMENT BOARD / COMMITTEE OF YOUR ORGANIZATION

Name Profession Function Country of Nationality On the board since

Mr Ms

Page 26 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 27 of 38

4. PARTNERS THE ACTION

27

OF THE APPLICANT PARTICIPATING IN

This section must be multiplied and completed for each partner organisation within the meaning of section 2.1.2 of the Guidelines for Applicants. Any associates as defined in the same section need not to be mentioned. You must make as many copies of these tables as necessary to create entries for all the project partners.

4.1

IDENTITY

Partner x Full legal name [in English and in the national language]

Date of Registration Place of Registration Legal status28 Official address of 29 Registration Country of Registration Region County/ Oblast District Town/Village/Commune Contact person Telephone number:
[country code + city code + number]

Fax number:
[country code + city code +

27 28 29

This section must be multiplied for each partner. E.g. non profit making, governmental body, international organisation If not in one of the countries listed in section 2.1.1 of the Guidelines, please justify its location

Page 27 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 28 of 38

number]

E-mail address Number of employees Other relevant resources Experience of similar actions, in relation to the role in the implementation of the proposed action History of cooperation with the applicant Role and involvement in preparing the proposed action Role and involvement in implementing the proposed action

Please provide the following information, if applicable, on the basis of the profit and loss account and balance sheet of your organisation, amounts in thousand Euros 30
Financial Data: Turnover or equivalent Net earnings or equivalent Total balance sheet or budget Shareholder s equity or equivalent Medium and long-term debt Short-term debt (< 1 year)

Year

N31 N-1 N-2

4.2

CAPACITY TO MANAGE AND IMPLEMENT ACTIONS (1 page per action, for all the project partners)

4.2.1 Experience in donor funded actions, in the same or similar sector(s) (max.1 page per action)
Please provide a detailed description of the actions managed by your partners over the past three years. This information will be used to assess whether the partnership has sufficient experience of managing actions of a comparable scale to the one for which the present grant is being requested.
30

If your project will be selected, these financial data will be checked and they should correspond to the amounts indicated here. 31 N = previous financial year

Page 28 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 29 of 38

Project title: Sector: Location of the action Cost of the Action (EUR) Please indicate the role of your organization in the project: Lead partner or partner Amount contributed [EUR] and 32 donor Dates
(from dd/mm/yyyy to dd/mm/yyyy)

Objectives and results of the action

4.3

JUSTIFICATION OF THE ELIGIBILITY OF PARTNERS LOCATED OUTSIDE THE

PROGRAMME AREA

For partners located outside the programme area (core area and adjoining regions) please fill in the table below with the required information: Explain why the project objectives cannot be achieved without this partner participation OR Demonstrate by making reference to legal acts that this partner: a) either is a central/national public sector body who has exclusive competence in the field covered by the Action and/or in the geographical area and its legal competences extends to the programme area; b) or is an international organisation

Explain how the proposed Action will be made for the full benefit of the programme area

IMPORTANT: This application form must be accompanied by a signed and dated partnership statement from each partner, in accordance with the model provided in section 4.4.

32

If the donor is the European Union or an EU Member State, please specify the EU budget line, EDF or EU Member State. Page 29 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 30 of 38

4.4

PARTNERSHIP STATEMENT33

A partnership is a relationship of substance between two or more organisations involving shared responsibilities in undertaking the action funded by the Contracting Authority (the Romanian Ministry of Regional Development and Tourism). To ensure that the action runs smoothly, the Contracting Authority requires all partners to acknowledge this by agreeing to the principles of good partnership practice set out below.

a) Our organization has read the application form and understood what our role in the action
will be before the application is submitted to the Contracting Authority.

b) Our organization got acquainted with the Joint Operational Programme Romania-UkraineRepublic of Moldova 2007-2013, read the Guidelines for Grant Applicants and the standard grant contract and understood what our respective obligations under the contract will be if the grant is awarded. We authorize the applicant to sign the contract with the Contracting Authority and represent us in all dealings with the Contracting Authority in the context of the action's implementation.

c) Our organisation has sufficient human, financial and administrative capacity to implement
the share of the Action as described in the Grant Application Form. Our organisation will be able to maintain sufficient financial liquidity to sustain implementation of the Action. d) The activities that our organisation will carry out in the Action are in line with the Community and national legislation and policies and with the rules of the Programme, in particular, on requirements for public procurement, environmental impact and sustainable development, equal opportunities, and non-discrimination. e) We are aware of the applicants obligation to consult our organisation and other partners regularly and keep us fully informed of the progress of the Action.

f) We have agreed with the applicant that he is obliged to send us copies of the reports narrative and financial - made to the Contracting Authority.

g) We are aware that proposals for substantial changes to the action (e.g. activities, partners,
etc.) should be agreed by the partners before being submitted to the Contracting Authority. Where no such agreement can be reached, the applicant must indicate this when submitting changes for approval to the Contracting Authority.

h) We are aware that where the Beneficiary does not have its headquarters in the country
where the action is implemented, the partners must agree before the end of the action, on an equitable distribution of equipment, vehicles and supplies for the action purchased with the EU grant among local partners or the final beneficiaries of the action.

i) We are aware of our obligation to sign a Partnership Agreement specifying the partners
tasks and obligations in the project, before the Applicant is signing the Grant Contract with the Contracting Authority. j) Our organisation will keep available all documents related to the Action in accordance with the programme requirements on the availability of documents.

k) Our organization will assume responsibility in the event of any irregularity in its own declared expenditures, and will repay the beneficiary the amounts unduly received/paid.

33

Please remember to multiply and fill in by each project partner Page 30 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 31 of 38

l) Our organisation will inform the public about Community assistance received from the
Programme to implement the Action in compliance with the visibility rules of the Joint Operational Programme Romania-Ukraine-republic of Moldova 2007-2013. Please choose one of the following and delete those which are not applicable: q Our organisation is not entitled to recover any paid VAT (Value Added Tax) by whatever means, and therefore all Action related expenditure to be reported will include VAT. q Our organisation is entitled to recover any paid VAT (Value Added Tax), and therefore all Action related expenditure to be reported will not include VAT. q Our organisation is entitled to partially recover the paid VAT (Value Added Tax), and therefore the respective Action related expenditure to be reported will not include VAT. For the partially non-recoverable paid VAT (Value Added Tax) by whatever means, the respective Action related expenditure to be reported will include VAT. I hereby certify that the [insert the name of the organization that fills in the partnership statement in English and in national language] commits itself to the operation and intends to provide and spend EUR [insert amount] as (national) co-financing to the project during its implementation, as well as any ineligible expenditure or any other costs related to the project implementation. This commitment is backed by the decision of the empowered bodies, available at request. I confirm that no expenditure related to the activities foreseen to be implemented in the above mentioned project by [insert the name of the organization that fills in the partnership statement in English and in national language] has been or will be funded by any other EU programme. I have read and approved the contents of the proposal submitted to the Contracting Authority. I undertake to comply with the principles of good partnership practice.

Signed on behalf of the Partner [insert the name of the organization that fills in the partnership statement in English and in national language]:
Name : Organisation: Position: Signature and stamp: Date and place:
34

34

Legal representative of the organization

Page 31 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 32 of 38

5. ASSOCIATES OF THE APPLICANT PARTICIPATING IN THE ACTION

This section must be completed for each associated organisation within the meaning of section 2.1.2 of the Guidelines for Applicants. You must make as many copies of this table as necessary to create entries for more associates. Associate 1 Full legal name Country of Registration Legal status35 Official address Contact person Telephone number: [country code + city code + number] Fax number: [country code + city code + number] E-mail address Number of employees Other relevant resources Experience of similar actions, in relation to role in the implementation of the proposed action History of cooperation with the applicant Role and involvement in preparing the proposed action Role and involvement in implementing the proposed action Relevance and added value of the associates

35

E.g. non profit making, governmental body, international organisation

Page 32 of 38

6. CHECKLIST FOR THE FULL APPLICATION FORM

Joint Operational Programme Romania-Ukraine-Republic of Moldova 2007-2013 Priority 3 People to people cooperation 2nd Call for proposals
ADMINISTRATIVE DATA Name of the Applicant Country and registration date
36

To be filled in by the applicant

of

Legal Entity File number Legal status37 Partner 1

Name: Country of registration: Legal status:

Partner 2 NB: Add partners as many rows as

Name: Country of registration: Legal status:

Before sending your proposal, please make sure that each of the following items is checked yes. Discrepancies between the Checklist that you have filled in and the content of the Grant Application Form may lead to the rejection of your application.

36 37

If the applicant has already signed a contract with the European Commission E.g. non profit making, governmental body, international organisation

2011
Grant application form for Priorities 1 and 2

Page 33 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 34 of 38

BEFORE

SENDING YOUR PROPOSAL, PLEASE CHECK THAT EACH OF THE FOLLOWING POINTS IS COMPLETE AND RESPECTS THE

FOLLOWING CRITERIA:

To be filled in by the applicant Yes No

Title of the Proposal: [indicate the title] PART 1 (ADMINISTRATIVE) 1. The correct grant application form, published for this call for proposals, has been used and filled in? 2. The Declaration by the applicant has been filled in, signed, stamped and included in original? Each partner has completed and signed a partnership statement and the statements are included in original? The proposal is typed and is in English?

3. 4.

One original and four copies are included? An electronic version of the project (CD-Rom) is enclosed and the CD- Rom includes the Full application form, Annex B Budget of the action and, if the case, Annex C Logical framework (if the requested grant is over EUR 100,000)? 7. 8. The budget is using the template published for this call for proposals, is expressed in EUR with 2 decimals and is enclosed? If necessary, the logical framework has been completed and is enclosed?

9. Environmental information (Annex F) has been completed and is enclosed? 10. Job descriptions for the key permanent staff are enclosed ?

11. Legalized mandates of delegation from the legal representatives of the applicant and partners are attached in original, if the case may be? PART 2 (ELIGIBILITY VERIFICATION) 12. The duration of the action is between 6 months (the minimum allowed by the call) and 18 months (the maximum allowed by the call)? 13. There is at least one partner from Romania and one partner from Ukraine or Republic of Moldova? 14. The applicant and partner(s) organisations are located in the programme area or participation of a partner located outside the programme area is fully justified in the full application form, in section 4.3? 15. The requested contribution is between 30,000 EUR (the minimum allowed by the call) and 150,000 EUR (the maximum allowed by the call)? 16. The EC requested contribution has not been modified by more than 20% of the total eligible costs as provided in the Concept Note (the maximum percentage allowed)? 17. The EC requested contribution is equal to or lower than 90% of the total eligible costs of the action?

Page 34 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 35 of 38

7. DECLARATION BY THE APPLICANT

The applicant, represented by the undersigned, being the authorised signatory of the applicant, in the context of the present call for proposals, representing any partners in the proposed action, hereby declares that: a a) b b) the applicant has the sources of financing and professional competence and qualifications specified in section 2 of the Guidelines for Applicants; the applicant undertakes to comply with the obligations foreseen in the partnership statement of the grant application form and with the principles of good partnership practice; the applicant is directly responsible for the preparation, management and implementation of the action with its partners, and is not acting as an intermediary; the applicant and its partners are not in any of the situations excluding them from participating in contracts which are listed in Section 2.3.3 of the Practical Guide to contract procedures for EC external actions (available from the following Internet address: http://ec.europa.eu/europeaid/work/procedures/implementation/index_en.htm. Furthermore, it is recognised and accepted that if we participate in spite of being in any of these situations, we may be excluded from other procedures in accordance with section 2.3.5 of the Practical Guide; the applicant and each partner are in a position to deliver immediately, upon request, the supporting documents stipulated under section 2.4 of the Guidelines for Applicants.; the applicant and each partner are eligible in accordance with the criteria set out under sections 2.1.1 and 2.1.2 of the Guidelines for Applicants; if recommended to be awarded a grant, the applicant accepts the contractual conditions as laid down in the Standard Contract annexed to the Guidelines for Applicants (annex IIA); the applicant and its partners are aware that, for the purposes of safeguarding the financial interests of the EU, their personal data may be transferred to internal audit services, to the European Court of Auditors, to the Financial Irregularities Panel or to the European Anti-Fraud Office.

c c) d d)

e e)

f f) g g)

h h)

The following grant applications have been submitted (or are about to be submitted) to the European Institutions, the European Development Fund and the EU Member States in the last 12 months:

[list only actions in the same field as this proposal]

The applicant is fully aware of the obligation to inform without delay the Contracting Authority to which this application is submitted if the same application for funding made to other European Commission departments or European Union institutions has been approved by them after the submission of this grant application. The applicant is aware that the partnership is a relationship of substance between two or more organisations involving shared responsibilities in undertaking the action funded by the Contracting Authority (the Ministry of Regional Development and Tourism). In this respect, the principles of good partnership practice set out below are acknowledged and agreed.

a) The applicant understood what his role in the action will be before the application is
submitted to the Contracting Authority.

b) The applicant read the standard grant contract and understood what his respective
obligations under the contract will be if the grant is awarded. He is authorized by the project partners to sign the contract with the Contracting Authority and to represent them in all dealings with the Contracting Authority in the context of the action's implementation.
Page 35 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 36 of 38

c) The applicant shall consult with its partners regularly and keep them fully informed of the
progress of the action.

d) The applicant will forward copies of the reports - narrative and financial - made to the
Contracting Authority to his project partners.

e) Proposals for substantial changes to the action (e.g. activities, partners, etc.) will be
previously agreed with all the project partners before being submitted to the Contracting Authority. Where no such agreement can be reached, the applicant must indicate this when submitting changes for approval to the Contracting Authority. f) Where the Beneficiary does not have its headquarters in the country where the action is implemented, the partners must agree before the end of the action, on an equitable distribution of equipment, vehicles and supplies for the action purchased with the EU grant among local partners or the final beneficiaries of the action.

g) The applicant is aware of his obligation to sign the Partnership Agreement stating the tasks
and obligations in the project, before the signature of the Grant Contract with the Contracting Authority. It is hereby certified that the [insert the name of the organization] commits itself to the operation and intends to provide and spend EUR [insert amount] as (national) co-financing to the project during its implementation, as well as any ineligible expenditure or any other cost related to the project implementation. This commitment is backed by the decision of the empowered bodies, available at request. Signed on behalf of the applicant Name Signature and stamp Position Date

Page 36 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 37 of 38

8. INDICATORS
The project will contribute to the achievement of the following programme indicator(s). Please, indicate by number the indicators that your project is contributing to (results and outputs). Indicate 1 each time your project is addressing a Result indicator.

PRIORITY 3 RESULT 1: Number of projects supporting common planning initiatives, exchange of experience, cooperation networks OUTPUT 1: Number of bodies involved in cooperation initiatives RESULT 2: Number of projects creating permanent social and cultural exchanges OUTPUT 2: Number of joint cultural events/networks promoting regional CBC identity, including awareness campaigns for environmental protection in the area RESULT 3: Number of projects fighting against organised crime, people trafficking in the border area OUTPUT 3: Number of trainings/meetings for professionals OUTPUT 4: Number of information campaigns for citizens and rehabilitation courses for victims of people trafficking RESULT 4: Number of projects creating activities for young population in the area OUTPUT 5: Number of exchanges and joint events for young people OUTPUT 6: Number of trainings/meetings for professionals

Number

9. ASSESSMENT GRID OF THE FULL APPLICATION FORM

(To be used by the Contracting Authority or the Evaluation Committee) YES OPENING AND ADMINISTRATIVE CHECK 1. The submission deadline has been respected 2. The application form satisfied all the criteria specified in part 1 of the Checklist of the application form (Section 6 of Part B of the Grant application form). DECISION 1: The evaluation committee decided to evaluate full application after having passed the administrative check. The administrative verification has been conducted by: Date: EVALUATION OF THE FULL APPLICATION FORM
DECISION

NO

2:
Page 37 of 38

2011 Grant Application Form for Priority 3 People to people cooperation

Page 38 of 38

A. The Committee has recommended the proposal for Eligibility verification after having been provisionally selected within top ranked second proposals within the available financial envelope B. The Committee has recommended the proposal for Eligibility verification after having been put on the reserve list according to the top ranked scored proposals The evaluation of the proposal has been conducted by: Date: ELIGIBILITY VERIFICATION 1. The application form satisfied all the criteria specified in part 2 of the Checklist of the application form (Section 6 of Part B of the Grant application form). 2. The supporting documents listed hereunder, submitted according to the Guidelines (Section 3.3.1), satisfy all the eligibility criteria of the applicant and its partner(s): a. The statutes or articles of association of applicant and all partners b. Certificates of Fiscal registration/ Certificate of tax payer registration for the applicant and all partners c. Certificate proving the fulfilment of the obligations relating to the payment of debts to the consolidated state budget d. Certificate proving the fulfilment of the obligations relating to the payment of debts to the local budget or, when not available, the self-declaration signed by the legal representative-for applicant and all partners e. The Legal Entity Sheet (see annex D of the Guidelines for Applicants) is duly completed and (for international organisations only) is accompanied by the letter of accreditation or a bilateral agreement -for the applicant f. The self-declaration, stating that documents proving ownership/ concession/ rent over the facilities are available and may be provided before signing the grant contract for the applicant and/or partner(s), as the case may be g. The declaration on compliance with state aid regulations (only for Romanian applicants and partners) The assessment of the eligibility has been conducted by: Date: 3: The Evaluation Committee has selected the proposal for funding after having verified its eligibility according to the criteria stipulated in the Guidelines for applicants.
DECISION

Page 38 of 38