APPLICATION FORM

For sub-granting of NGOs, CSOs and Educational Institutions

Project “DISTANCE SUPPORT SAD - I Bambini del Futuro”

Call for proposal No 1

Deadline for submission of applications: May 31, 2017

Title of the action:
Type of the action / 1.One-off event 2. Project
Location(s) of the action:
Name of the applicant
Country of registration of the applicant
Applicant's contact details for the purpose of this action
Postal address:
Telephone number: (fixed and mobile) Country code + city code + number
Fax number: Country code + city code + number
Contact person for this action:
Contact person's email:
Website of the Organization:

1.Summary of the action

Please complete the table below which should not exceed 1 page.

Title of the action:
Location(s) of the action: - specify country(ies), region(s), town(s), village(s) that will benefit from the action
Total duration of the action (months):
Requested Amount in €
Objectives of the action
Beneficiaries
Estimated results
Main activities

2.Relevance of the action (max 2 pages)

  • Describe the relevance of the proposed action to the objective and priorities of the call for proposals.

3.Description of the action (max 2 page)

  • Describe the objectives of the action (elaborate here on the objectives mentioned in the table in Section 1. above).
  • Provide a detailed description of the activities foreseen. Specify related outputs and results.
  • Describe your plan for monitoring and evaluation if any.
  • Describe your plan for visibility of the action.
  • Describe any plans to develop this action into a longer initiative/action.

.Provide the information about a) Duration and b) Action Plan for implementing the action. The action plan will be drawn up using the following format:

Activity / Day 1 / Day 2 / 10 Days / 10 Days / Implementing body
Example / example / Example

4.Identity of the Applicant

  • Legal data about the Applicant

Registration Number
VAT Number
Date of Registration
Place of Registration
Official address of Registration
Country of Registration/ Nationality
Legal status
Name and the address of the Bank
Bank Account number
  • Capacity to manage and implement actions

Number of staff
Number of volunteers
Other resources (office, equipment…)
Experience in managing / implementation other projects
Project 1
Title of project
Period of realization
Donor and amount
Most important results
Project 2
Title of project
Period of realization
Donor and amount
Most important results

5.Declaration by the applicant

The applicant, represented by the undersigned, being the authorized signatory of the applicant, hereby declares that

The applicant has the capacity to manage and implement the proposed action;

The applicant is directly responsible for the preparation, management and implementation of the action and is not acting as an intermediary;

The applicant is not in any of the situations excluding them from participating in contracts which are listed in the Call for Proposals;

if recommended to be awarded a grant, the applicant accepts the contractual conditions as laid down in the Standard Contract annexed to the Call for proposals;

if recommended to be awarded a grant, the applicant accepts the conditions for any visibility actions as laid down in the Visibility Rules annexed to the Call for proposals.

The applicant will immediately inform the Contracting Authority if another donor approves this same application for funding after the submission of this grant application.

Signed on behalf of the applicant

Name
Signature
Position
Date

NGO "Shpresa e Jetës"Address: str. Imzot Nikë Prela,Konvikti i Vajzave, nr.60, Ulpiane,10 000 Prishtinë, Kosovë Email:ce: ++381 38542 241 Mobile: ++377 45 424 930