Registration number: (will be completed by IKEA Romania)

„Together for the most important people in the world”

Programto supportlocalcommunities in theBucharestand Ploiesti area

SPONSORSHIP REQUEST

Organization
The name of the applying organization:

Contact address:

Street: / No. / Block / Entr. / Ap.
Postal code: / City: / Region:
Registration address of the organization:
Street: / No. / Block / Entr. / Ap.
Postal code: / City: / Region:

Organization type:

Association  Foundation Federation

Organization level: National  Regional  Local Federation

Number of (active) members:
Bank:
IBAN code (Romanian lei):
Tax code:
Phone: / Fax:
E-mail: / Web:
Management team (name/function/address):
Budget for 2012:
Estimated budget for 2013:
1st partner(only if necessary: if the consent from the partner is needed for project implementation)
Name:
Contact address:

Organization type:

 NGODepartment for Child ProtectionSchool KindergartenOther

Phone: / Fax:
E-mail: / Web:
Contact person:

Project

Title:
Project launch: / End date:
Budget:
Project coordinator:
Name______Surname______
Job______Function______
B.I./C.I.series _____ no. ______issued by ______date______
Address: City ______Region ______
Str.______no.____block _____ entr. ___ floor ____ap.____
Phone______e-mail______

1. Organization presentation(purpose, targetgroupthrough activities, dateofestablishment,main results, projects undertaken, previousgrants-max. 30 lines)

2. Partner(s) (goal,targetgroupthrough activities, dateof establishment,main results, projects undertaken, previousfunding-max. 30 lines for each partner)

3. Project description- Annex A

3.a Actual purpose of the project(the goal is the stage where we want to get to on the matter as a result of the project.) - max. 3 rows

3.bProject objectives – max. 10 rows

3.c Project justification – max. 1page

-Presentation of the problemto be solvedby the project;

- The need foractivitiesundertakenin the project;

- ConnectionwithIKEAvision: better everydaylifeformore people;

- Target group/activity;

- Project beneficiaries (preferablydivided oneach activity);

- Target group, beneficiaries;

- Concreteexpectedresults;

- Evaluation of the results.

3.d. Brief descriptionof project activities-max. 1 page(table format recommended)

3.e Long-termsustainability of the outcomesandproject continuation

4. Project budget

Budget chapter /

Total budget

EURO

/ Approved budget
(will be completed by IKEA Romania)
Personal
Personal training
Equipment
Teaching materials
Communication/project promotion materials
Consumables
Communication costs (phone, post etc.)
Transport
Meals
Other expenses

Total

6. Detailand justify theestimated expenditure- fill inAnnexB: ActionPlan

7. Otherfunding sources(Specify ifyou have requestedfunds for this projecttoother donorsandwhat is the statusof theserequests.)

AFFIDAVIT:We declare that all the above information are consistent with the truth.

Name of the project coordinatorOrganization President (Manager)

______

Signature ______Signature ______

Stamp

Date______

City______

Projects will be presented in 3 (three) printed copies in English.

Projects must be accompanied by the following annexes:

-Association statute (copy);

-Court decision setting up the non-profit legal entity (copy);

-Proof of non-profit legal entity registration in theNon-Profit Associations and Foundations Register (copy);

-Written agreements from organizations / institutions that will collaborate throughout the project;

-Project manager resume.

-Contract of custody / administration (copy) - if necessary

Annexeswill be sentin asingle copy.

Projectstogether with the annexescan be sentby postand courierorcanbedelivered in personat:

Cristian Clita (+4 0726 772 262)

IKEA Romania Store

București-Ploiești Street, no.42A

(Băneasa Commercial Area)

1stBucharest

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