Request Form for SOCIEUX technical assistance

(Version 21/10/2013)

This request form should be filled out either in English or French and be accompanied by all supporting documents considered relevant. It can be sent by email, letter or fax to (if possible putting in copy the EU Delegation in the country):

SOCIEUX – Social Protection European Union Expertise

in Development Cooperation

Avenue Paul Deschanel 62, 1030 Brussels, Belgium

Telephone: +32 25884884 / Fax: +32 25884880

E-mail:

ec.europa.eu/europeaid/socieux

Title of the request
(mention the core question/ issue of the request)
Requesting institution(s)
Country
Date of submission
  1. Contact person and authorising person representing the requesting institution

1.1.Contact person (acting as main coordinator)

Title (Mr, Ms.)
First Name
Family name
Name of institution
Department
Position/Job title
Office address (street/ number/ office number
Town/ City
Province / County
Country
Phone number
Fax number
Email address

1.2.Authorising person (e.g. director, head of department)

Title (Mr, Ms.)
First Name
Family name
Name of institution
Department
Position/Job title
Office address (street/ number/ office number
Town/ City
Province / County
Country
Phone number
Fax number
Email address

1.3.Requesting institution(s)’mandate and role(max 1 page)

Please describe the mandate of your institution/organisation and its role in designing and or implementing social protection in your country.

  1. Background information on social protection

2.1. What are the social protection policies and programmes in your country?(max 1 page)

Please summarize the main social protection policies and programmes relevant to the request and attach any supporting documents providing additional information.

1.1.What reform measures are you currently planning/undertaking? (max 1 page)

  1. Description of the request for assistance

2.1. Objective of the request for assistance(max 1 page)

What is objective(s) of the assistance and what specific challenge(s)/problem(s) is this request for assistance aimed to address?

2.2.What type of technical assistance supportis most appropriate for you?

Please mark the type(s) of technical assistance support you consider most appropriate for the request of assistance.

SOCIEUX interventions / Mark if relevant / Comments
Capacity building
Legal/ regulatory framework
Policy/strategy development
Management and administration
Financing and budgeting
Communication and PR
IT systems
Other

2.3.On which areas of social protection you need assistance?

Please identify (and define if necessary) the main social protection areas on which you will need SOCIEUX assistance. For your reference you can find a non-exhaustive list of social protection areas under section 1.3. of the Guide for Partner Country Institutions.

2.4.Type of expertise needed(max 1 page)

Please identify the expertise needed: number of experts and their profile.

N.B. The categories of experts which will deliver the technical assistance needed are detailed in the Guide for partner institution/participantsunder section’Experts delivering SOCIEUX technical assistance’.

2.5.Expected results of the action(max 1 page)

Please point out the expected results for which the technical assistance is requested.

2.6.Duration of requested assistance

Please make an estimation of the duration of the overall assistance and indicate when you expect this to be carried out.

N.B: A SOCIEUX action consists either of one or a series of Activities; each Activity consists of a short-term mission of 1-2 weeks carried out by one or several Experts.

Duration of the action
(estimated number of days of the technical assistance)
Estimated period(Month/Year)
  1. Authorising person’s declaration

Name:

Position:

Signature Date…………………………….

1