Website CG Belgium - Jerusalem 30 May 2012

Micro-project Application form

Title:
Location:

1.1 Applicant General Information:

Name of Institution :
Full address: / Name of institute:
Building:
Street:
P.O.Box:
City:
Telephone number:
E-mail of the Institution:
Website of the Institution:
Contact person:
Contact person’s email:

1.2: DESCRIPTION OF APPLICANT

Year of establishment of the organization
Names of Cofounders
Mission & objectives
Organization activities
Future activities

1.3: Project Information:

Needs for the Project
Objectives of the Project
Projects Outcomes
Target Group
End Beneficiaries
Estimated Cost / Budget
Starting Date
Ending Date
Duration
List of Activities

1.4 Resources needed

Human Resources
Physical Resources
Financial Resources

1.5 Action plan

The duration of the action will be ______ months (not more than 1 year!).

Note: The indicative action plan must not mention real dates, but must simply show "month 1", "month 2", etc. Applicants are recommended to leave a certain amount of slack in the timetable of their action plan as a precaution. The action plan should not include detailed descriptions of activities, but just their title. Any months without activities must be included in the action plan and the duration of the action.

The action plan must be drawn up using the following format(not more than 5 activities):

Activity
1 / 2 / 3 / 4 / 5 / 6 / 7 / 8
Activity 1:
Activity 2:
Activity 3:

1.6 Budget

Indicate the project activities and estimated budget needs in the below format, based on your activities listed in 1.5. All amounts should be in EURO.

Activity 1: / Unit description / Price / Budget EURO
1 / XXX / X
2 / XXX / X
3 / XXX
4 / XXX
5 / XXX
A- Sub Total / XXXX
Activity 2:
1 / XXX
2 / XXX
3 / XXX
4 / XXX
5 / XXX
B- Sub Total / XXXX
Activity 3:
1 / XXX
2 / XXX
3 / XXX
4 / XXX
5 / XXX
C- Sub Total / XXXX
Grand Total (A+B+C) / XXXXX