NGO Programme - Greece EEA Financial Mechanism APPLICATION FORM FOR THE OUTCOME DEMOCRATIC VALUES, INCLUDING HUMAN RIGHTS, PROMOTED

Transcription

1 NGO Programme - Greece EEA Financial Mechanism APPLICATION FORM FOR THE OUTCOME DEMOCRATIC VALUES, INCLUDING HUMAN RIGHTS, PROMOTED Athens September

2 Before filling in the application, please read the guidelines for applicants carefully. Τhe word limits must be strictly followed. Applicant s Name: SECTION 1 BASIC INFORMATION Applicant s Name in English: Project Title: Project Title in English: Project Budget: Partner s Budget (if there are more than one partners, please add fields as required): Partner s Budget Percentage (up to 20% of the total budget for each partner. If there are more than one partners, please add fields as required): Total Number of Pages of the Project Application including the annexes: Summary of the project in Greek (Must mention briefly the aims of the project, the target groups, and activities. Up to 10 lines): 2

3 Summary of the project in English (Must mention briefly the aims of the project, the target groups, and activities. Up to 10 lines): 3

4 2.1. General Information SECTION 2 APPLICANT INFORMATION Eligible applicants are NGOs that are established in Greece and fall within the following definition: A non-profit voluntary organisation established as a legal entity, having a noncommercial purpose, independent of local, regional and central government, public entities, political parties and commercial organisations. Religious organisations and political parties are not considered NGOs. Legal Status (Please mark with X) Association Civil non-profit company Foundation OTHER (Please specify): Year of establishment Registered Number (AFM) Tax Office (DOY) Registered Address Street, number City Prefecture Municipality Postcode 4

5 2.2. Contact information Telephone Number address Website Legal representative First Name Last Name Father s Name Position within Organisation Profession Telephone Number address Contact Person (only if different from legal representative) First Name Last Name Father s name Position within Organisation Position Telephone Number address 2.3. Description of Applicant Organisation Statutory Purpose Geographical Scope of Activities Thematic field of activities Target groups benefiting from the organisation Financial turnover of Analytical list of the sources of funding for the last two years (2013 and 2014) 5

6 Α/Α Source of funding Amount Number of Members Number of Active Members Number of employees under any employment relationship (permanent, seasonal, part time, etc.) Number of volunteers 2.4. Previous Projects Please describe your past projects and activities in the last 2 years using the table below. (Insert additional rows for additional projects) Project Title Main Activities Funding entity Budget (in euros) Amount managed by the organisation Period of implementation (MM/YY) Other partners (if any) 6

7 SECTION 3 PARTNER ORGANISATION(S) (IF ANY) The project promoter can implement the project alone or in cooperation with its partners. Eligible project partners are public or private legal entities having a commercial or non-commercial aim, or non-governmental organisations, whose primary location is in (a) a Donor State, (b) a Beneficiary State or (c) in a country outside the European Economic Area that has a common border with Greece, (d) an intergovernmental organisation that can participate and contribute in the implementation of the project. The partner and the project promoter must have a common economic and social target that will be attained with the implementation of the project. The partners role must be justified and explicitly analyzed with that of the project promoter General Information Full Legal Name Full Legal Name in English Country (Please mark with X) Intergovernmental Organisation Greece Norway Iceland Liechtenstein Bulgaria Croatia Cyprus Donor States Beneficiary States 7

8 Czech Republic Estonia Hungary Latvia Lithuania Malta Poland Portugal Romania Slovakia Slovenia Spain Albania FYROM Turkey States outside the EEA that share a border with Greece Legal status (Please mark with X) Association Civil non-profit company Foundation Public/ Governmental entity Private entity OTHER (please specify) Year of establishment Registered Number (AFM) Tax Office (DOY) Registered Address 8

9 Street, number City Prefecture Municipality Postcode 3.2. Contact information Telephone Number address Website Legal representative First Name Last Name Father s name Position within Organisation Profession Telephone Number address Contact Person (only if different from legal representative) First Name Last Name Father s name Position within Organisation Profession Telephone Number address 3.3. Description of Project Partner Organisation Statutory Purpose Geographical Scope of Activities Thematic field of activities 9

10 Target groups benefiting from the organisation Financial turnover of Analytical sources of funding of the last two years (2013, 2014) Α/Α Source of funding Amount Number of Members Number of Active Members Number of employees under any employment relationship (permanent, seasonal, part time, etc.) Number of volunteers 3.4. Role of Project Partner Organisation Please describe the role of the partner organisation in the project. (up to 20 lines) 3.5. Previous Projects Please describe the partner s past projects and activities in the last 2 years. (Insert additional rows for additional projects) 10

11 Project Title Main Activities Funding entity Budget (in euro) Amount managed by the organisation (in euro) Period of impleme ntation (MM/YY) Other partners (if any) *Please duplicate Section 3 for additional partners 11

12 SECTION 4 PROJECT DESCRIPTION 4.1. Project Objectives Describe the project and its objectives (up to 20 lines) Target Group(s) From the list below, please select who is/are the expected target group(s) for your project (Please mark with X) General population Children (up to 18 years of age) Young Adults (18 to 30 years of age) Disabled Unemployed People at risk of poverty 12

13 Migrants Refugees Asylum-seekers Roma LGBT( lesbian, gay, transsexual, bisexual) OTHER (Please specify): If you included children or youth in the target groups, please indicate the amount of funding that will be allocated to cover their needs What problem does the project aim to resolve or address? Please include specific references, supported by statistics and bibliographic references, references to legal frameworks, consultation procedures etc., if possible. (Up to 20 lines) Which other entities are active in the thematic area of the project? In what ways? What is the comparative advantage of the intervention you are suggesting (Up to 20 lines) 13

14 4.2. Contribution to Outcome Explain your project s contribution to the achievement of the outcome Democratic values, including human rights, promoted (up to 15 lines) 4.3. Contribution to Areas of Support Select the area(s) of support that your project addresses from the following list: Democracy Human rights including minorities rights (in particular Roma, immigrants, migrants and asylum seekers) Good governance and transparency Participatory democracy Combat racism, xenophobia and hate crime Anti-discrimination on all grounds, including sexual orientation Social inequalities, poverty and exclusion, including in rural areas Gender equality Gender-based violence Anti-corruption Trafficking in human beings Capacity building Active citizenship and human rights awareness-raising Networking and coalition building among NGOs Protection of the environment and climate change Explain how your project will address the Area(s) of Support selected above. (Up to 20 lines) 14

15 4.4. Main activities Select the categories of activities that your project includes (Please mark with X): Capacity building activities and organisational support to NGOs; Awareness raising activities; Multicultural dialogue activities; Mutual learning and dissemination; Education and training activities; Network and coalition building; Provision of welfare and basic services; Advocacy, watchdog and monitoring activities; Participation in policy and decision making processes; Cultural initiatives to promote areas of support referred to above Describe your project s main specific activities that correspond to the categories above. (Up to 30 lines)): 15

16 4.5. Monitoring, control and evaluation of the project Please fill in the project outputs and their indicators, including baseline and target values. You can add outputs, indicators and baseline and target values as required (see Annex 2 of Guidelines). Output 1 Indicator Baseline Value Target Value Source of verification Indicator 1 Indicator 2 Output 2 Indicator Baseline Value Target Value Source of verification Indicator 1 Indicator 2 Output 3 Indicator Baseline Value Target Value Source of verification Indicator 1 Indicator Capacity Building Describe how the project implementation will contribute to the strengthening of the capacity of your organisation? (Up to 10 lines) 16

17 4.7. Project Duration The projects can begin from the signing of the project contract and should be completed no later than 30 April The duration of small projects cannot exceed six (6) months and that of large projects twelve (12) months. Total project duration (in months) Please fill in the estimated start and end dates of the project From MM/YYYY Until ΜΜ/YYYY 4.8. Project Location Specify where your project activities will be undertaken. (Please mark with X in one of the fields below) Greece: National level Regional level Local level If you have selected regional or local level, please specify exact location: 4.9. Sustainability of the project results 17

18 Describe how you plan to ensure the sustainability of project results in the long term. Describe the plan for the propagation and dissemination of the project results and its usefulness for other NGOs, public or private bodies active in the field concerned. (Up to 20 lines) 18

19 SECTION 5 COMMUNICATION PLAN FOR THE GRANT Please describe the communication plan for the grant. This does not include awareness raising activities that have been included in the main activities of the project. Communication goals Target group(s)/ Audience(s) Suggested communication activities Targeted media Communication content Means of evaluation of communication plan SECTION 6 HORIZONTAL CONCERNS & CROSS-CUTTING ISSUES 6.1. Horizontal Concerns Please describe your project s contribution to the promotion of horizontal concerns: Hate speech Please describe the project s contribution to tackling this issue Discrimination and hate crime Please describe the project s contribution to tackling this issue Racism and xenophobia Please describe the project s contribution to tackling this issue 19

20 Homophobia Please describe the project s contribution to tackling this issue Anti-Semitism Please describe the project s contribution to tackling this issue Tolerance and multicultural understanding Please describe the project s contribution regarding this issue Roma Please describe the project s contribution regarding this issue Sexual harassment Please describe the project s contribution to tackling this issue Gender based violence Please describe the project s contribution to tackling this issue Human Trafficking Please describe the project s contribution to tackling this issue 6.2. Cross-cutting Issues Describe your project s compliance with the cross-cutting issues of the Programme (hyperlink). (Please mark with X in one of the fields). Good governance Direct positive influence Indirect positive influence Not applicable Please describe contribution of the project to promoting good governance: 20

21 Social sustainability Direct positive influence Indirect positive influence Not applicable Please describe contribution of the project to promoting social sustainability: Economic sustainability Direct positive influence Indirect positive influence Not applicable Please describe contribution of the project to promoting economic sustainability: Environmental sustainability Direct positive influence Indirect positive influence Not applicable Please describe contribution of the project to promoting environmental sustainability: Gender Equality Direct positive influence Indirect positive influence Not applicable Please describe contribution of the project to promoting gender equality: 21

22 ANNEXES 1. SIGNED DECLARATION OF THE PROJECT PROMOTER 2. PARTNERSHIP STATEMENTS 3. PROJECT TIMELINE 4. PROJECT PROMOTER S STAFF 5. PROJECT PARTNER S STAFF 6. CVs TEMPLATE 7. DOCUMENT CHECKLIST 22

23 ANNEX 1 DECLARATION OF THE PROJECT PROMOTER [Place, Date] To Whom It May Concern: I, the undersigned [first, last and father s name of representative] in the capacity of authorised representative acting for and on behalf [name of organisation] declare that: 1. All information contained in this application, is correct to the best of my knowledge. 2. The organisation I represent has the adequate legal capacity to participate in the call for proposals. 3. The organisation I represent has financial and operational capacity to complete the proposed project. 4. I am authorised by my organisation to sign grant agreements on its behalf. 5. The activities I am applying for under the NGO Fund for Greece within the EEA Grants are not funded by national, EU and/or other external donors sources. 6. The organisation does not fall into any of the situations provided below: 1. is bankrupt or has its affairs administered by the courts 2. any of its directors and/or managers has been convicted for any offence related to professional misconduct, 3. has not fulfilled its obligations relating to the payment of social security contributions or the payment of taxes to the Republic of Greece. In the event of this application being approved, the Fund Operator has the right to publish the name and address of this organisation, the subject of the grant and the amount awarded and the rate of funding. 23

24 Sincerely, [signature] [stamp] 24

25 ANNEX 2 PARTNERSHIP STATEMENT Partnership statement for the project (Title of the project) I, as responsible official of the Project Partner Title of the Project Partner First name, family name confirm, that Partner organisation: Position 1. Corresponds to all the eligibility provisions of project partners; 2. Is familiar with the project application and is aware of its own role in the project implementation; 3. Is familiar with the conditions for receiving grant, which are defined in the respective grant regulations, and undertakes to respect them during the implementation of the project; 4. Confirms that all the information about the Partner organisation provided in the project application and attached documents is correct; 5. Has appropriate experience and knowledge to fulfil the tasks foreseen in the project application; 6. Undertakes to follow the publicity requirements while implementing the project activities and publishing information materials; 7. Undertakes to keep all documentation connected to the project implementation five years after approval of the final project report, as well as consents to controls and audits of institutions of the donor countries during the project implementation or during five years after approval of the final project report; 25

26 8. Authorizes the Project Promoter to represent the Partner organisation in communication with the Programme Operator regarding issues of the project implementation; 9. Undertakes to fulfil all the tasks foreseen in the project application and to provide all necessary information upon the request of the Project Promoter. Signature Date 26

27 ANNEX 3 PROJECT TIMELINE Month April 2015 May 2015 June 2015 July 2015 Aug Sept Oct Nov Dec Jan Feb March 2016 April 2016 Activity 27

28 List the staff involved in the project: ANNEX 4 PROJECT PROMOTER S STAFF Must be completed for each of the key persons of the promoter of the project and be accompanied by the corresponding CVs (following the templates specified below). NAME PROFESSION POSITION IN THE PROJECT TYPE OF EMPLOYMENT 28

29 ANNEX 5 PROJECT PARTNER S STAFF List the staff involved in the project: Must be completed for each of the key persons of each partner organisation implementing the project, which will participate in the project, and be accompanied by the corresponding CVs (following the templates specified below). NAME PROFESSION POSITION IN THE PROJECT TYPE OF EMPLOYMENT 29

30 ANNEX 6 CURRICULUM VITAE TEMPLATE *The Curriculum Vitae should be completed for each of the key persons to be involved in the project both of the project promoter and the project partner. 1. Contact First Name Last Name Father s name Profession Position within organisation Telephone Number address 2. Description of tasks in the Organisation (Up to 5 lines) 3. Education Educational Institution Dates (MM/YYYY MM- YYYY) Field of study Degree or Diploma 4. Professional Experience Company/ Dates (MM/YYYY Organisation MM- YYYY) Position Description of tasks 30

31 5. Membership in professional bodies: 6. Other skills (e.g. computer literacy, languages, etc.): 7. Specialised experience related to the project (up to 10 lines): 31

32 ANNEX 7 DOCUMENT CHECKLIST Basic Application Contents Check Comment 1 Filled in and complete application form 2 Budget form 3 CD/USB 4 Partnership Agreement Documents of the Project Promoter 5 Statute of the Organisation- and all the amendments 6 Establishment document of the Official government registry(for Foundations) 7 Certificate of Court / Magistrate for recording - setting modifications 8 Minutes of Elections of Board, legal representatives and other statutory bodies (e.g. General Assembly, Supervisory Board ) 9 Pending legal issues - if any, written confirmation by the legal representative, stating that the Agency has no legal backlog 10 Valid tax statement 11 Valid insurance statement 12 Signed Declaration of the project promoter 13 List of personnel that will participate in the project 14 CVs of personnel 32

33 15 Certificate of commencement of operations and any changes by the competent Tax Office 16 Tax declarations of the last two years 17 Tax clearance certificate 18 Last tax statement of estate 19 Balance sheets of the last two years 20 Budgets of the last two years 21 Accounts of the last two years Documents of the Project Partner 22 Statute of the Organisation- and all the amendments validly published 23 Establishment document of the Official government registry(for Foundations) 24 Certificate of Court / Magistrate for recording - setting modifications 25 Minutes of Elections of Board, legal representatives and other statutory bodies (e.g. General Assembly, Supervisory Board) 26 Pending legal issues - if any, written confirmation by the legal representative, stating that the Agency has no legal backlog 27 Valid tax statement 28 Valid insurance statement 29 List of personnel that will participate in the project 30 CVs of personnel 31 Certificate of commencement of operations and any changes by the competent Tax Office 32 Tax declarations of the last two years 33

34 33 Tax clearance certificate 34 Last tax statement of estate 35 Balance sheets of the last two years 36 Partnership agreement 37 Budgets of the last two years (2014 and 2015) 38 Accounts of the last two years PLEASE SUBMIT THE APPLICATION FORM IN WORD FORMAT 34