Be Active Scheme:

Developing Ideas Together

Application 2017

For office use only
Proposal no:
Date and time when proposal was handed in:
SECTION ONE

1.Details of the organisation

Name of the organisation:

Official address of the organisation (correspondence that is sent by post will be sent to this address):

Number and name of the premises:
Street:
Locality:
Post code:
VO Number: / AZ Registration Number:
Email address:
Website:

Profile of the organisation: (300 words max)

1.1Details of the legal representative (the person that will represent the organisation and will take responsibility for the implementation of the project )

Name and Surname
ID Card No:

Address:

Number and name of premises
Street
Locality
Post Code
Mobile/Telephone No
Email address:

Did you ever benefit from public funds:

Yes

No

If Yes, Kindly specify the name(s) and dates of the project(s), awarded between 2015-2016

SECTION TWO
The initiative

2.1 Aims of the initiative

Choose the theme that the initiative is going to address

No Hate Speech Campaign

Healthy Lifestyles

Volunteering

Entrepreneurship

Enhancing Soft Skills

2.2 Description of the initiative

Give a clear and detailed description of the initiative

Title of the initiative (give a short title)
Location/s where the initiative will take place:
Starting date* / _ _/_ _ /_ _ _ _ / End date* / _ _/_ _ /_ _ _ _

*N.B. – The initiative has to be implemented between February and mid-October2017.

Short description of the initiative (summary) - maximum 300 words
What are the objectives of this initiative? Who is the target audience of this initiative and why? - maximum 300 words
How will the initiative manage to achieve the objectives you mentioned in the previous question? Provide a detailed description of the activity/activities. – maximum 600 words
How does the initiative link to vision for young people set out in the National Youth Policy 2015-2020? Discuss in view of project objectives and activities proposed. – maximum 300 words

2.3 Activities timetable:

Together with your application you are to provide a timetable of activities, clearly indicating the plan of action for the coming months. You can choose a format that suits you best as long as it provides clear and detailed information: indicating activities planned for each phase of the project and reasons why.

2.4 Who will be responsible for the implementation of each phase of the initiative?

Name and Surname
Role
ID Card No:
Address:
Number and name of premises
Street
Locality
Post code
Mobile/Telephone
Email address
Name and Surname
Role
ID Card No:
Address:
Number and name of premises
Street
Locality
Post code
Mobile/Telephone
Email address
Name and Surname
Role
ID Card No:
Address:
Number and name of premises
Street
Locality
Post code
Mobile/Telephone
Email address
Name and Surname
Role
ID Card No:
Address:
Number and name of premises
Street
Locality
Post code
Mobile/Telephone
Email address
Name and Surname
Role
ID Card No:
Address:
Number and name of premises
Street
Locality
Post code
Mobile/Telephone
Email address
What health and safety measures will you be taking during the implementation of the intiative? – maximum 300 words
What measures will you take in order to ensure visibility of intiative? – maximum 300 words
How and to whom will the group disseminate the outcomes and results that will emerge from the implementation of the initiative? (maximum 300 words)

Kindly check the following box/es by indicating the targeted amount of young people that you intend to reach through your initiative from each bracket according to gender.

The initiative aims to reach how many young people:

Age bracket / No of Males / No of Females
Between 13 and 15
Between 16 and 20
Between 21 and 25
Between 26 and 30

SECTION THREE

Budget

3.1 Description of the budget

Provide a description of the budget. The expense has to be realistic and in line with the aims of the initiative.

Month / Description of the expenserelated to the preparation phase / Amount
€
Total
Month / Description of the expense involved in the implementation phase / Amount
€
Total
Month / Description of the expense related to the dissemination and evaluation of the initiative / Amount
€
Total

SECTION FOUR

Declaration and signature

I, as legal representative of ______hereby request that our application is accepted for evaluation.

I, hereby declare that I am aware that in order to be eligible for funding this proposal has to be selected. I also declare that my organisation is aware that if the initiative is selected it will be implemented in accordance to the rules and regulations and in line with the contract that will be signed once the initiative is approved.

Details of the legal representative:

Name:

ID Card No:

Date:

Signature:

Official stamp of the organisation:

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