Application Form for the open Call

"Supporting innovative initiatives for children and youth in local communities"

Please consult the Guidelines for Applicants before filling out this form

Please fill out this form using a computer

We are applying for this project:

As a single applicant
In partnership (partner can use the grant funds)

This project fosters democracy and human rights through (mark only one of the two, see also question II.10. in this Application Form):

Empowerment of vulnerable groups
Promotion of democratic values, including human rights
I.a. BASIC INFORMATION ABOUT THE SINGLE APPLICANT / PROJECT COORDINATOR
1. / Name of the organization (in Croatian)
2. / Name of the organization (in English)
3. / Official/registered adress of organization (country / postcode / city / address)
4. / Visiting adress of organization (country / postcode / city / address) - if different from above
5. / County
6. / Telephone
7. / Fax
8. / E-mail
9. / Website and/or Facebook
10. / Name and position of the person responsible for the representation of the organization
11. / Name and position of the contact person of the organization (with contact details if different from above)
12. / Year of the founding
13. / Date and year of the registration
14. / Registry number (No. from the Registry of NGOs or Registry of Foundations)
15. / Registered in the office (county/city)
16. / OIB (Personal identification number)
17. / RNO (Number from the Registry of non profit organizations)
18. / Account number / IBAN
19. / Name of the bank
20. / Is the organization registered in VAT system? (Yes/No) / Yes (If yes, please attach relevant documentation) / No
21. / If the organization is in VAT system, is VAT for any expense from the Budget Form recoverable from the Government? / Yes (If yes, please attach the list of recoverable expenses) / No
22. / Aims of the organization, according to the Statute
23. / Number of employees in the organization
24. / Portion of the voluntary work in the organization:
a) number of persons volunteering
b) number of voluntery hours in 2014.
25. / Total income of the organization in 2014.
26. / Of the total income, from:
a) state budget
b) budget of the local (self) government
c) own funds from eligible economic activities
d) income from membership fee
e) donation from profit organisations
f) donation from citizens
g) donation from international entities including EU funding
27. / Information on the office
a) own office space (m2)
b) rented office space (m2 and price)
c) office space from the State/County - without paying
I.b. BASIC INFORMATION ABOUT THE PARTNER ORGANIZATION (if applicable)
1. / Name of the organization (in Croatian)
2. / Name of the organization (in English)
3. / Official/registered adress of organization (country / postcode / city / address)
4. / Visiting adress of organization (country / postcode / city / address) - if different from above
5. / County
6. / Telephone
7. / Fax
8. / E-mail
9. / Website and/or Facebook
10. / Name and position of the person responsible for the representation of the organization
11. / Name and position of the contact person of the organization (with contact details if different from above)
12. / Year of the founding
13. / Date and year of the registration
14. / Registry number (No. from the Registry of NGOs or Registry of Foundations)
15. / Registered in the office (county/city)
16. / OIB (Personal identification number)
17. / RNO (Number from the Registry of non profit organizations)
18. / Account number / IBAN
19. / Name of the bank
20. / Is the organization registered in VAT system? (Yes/No) / Yes (If yes, please attach relevant documentation) / No
21. / If the organization is in VAT system, is VAT for any expense from the Budget Form recoverable from the Government? / Yes (If yes, please attach the list of recoverable expenses) / No
22. / Aims of the organization, according to the Statute
23. / Total income of the organization in 2014.
II. INFORMATION ABOUT THEPROJECT
1. / Title of the project in Croatian
(max 10 words)
1.a / Title of the project in English (max 10 words)
2. / Beginning and end of project (NOTE: duration of the project from 6 up to 12 months, with the start date considered to be the contract signature - provisional date is set to June 2015)
3. / Total amount needed for the project
3.a / Costs share of the project coordinator (in case of application in partnership)
3.b / Costs share of the project partner (in case of application in partnership)
3.1. / Amount asked in the Budget Form from the EEA/NG (max. 90%)
3.2. / Amount of co-financing (min. 10%)
3.2.1 / Amount of co-financing in the form of cash
3.2.2 / Amount of co-financing in the form of in-kind contribution - voluntary work (not more than 50% of the total co-financing)
4. / Detailed description of the project and how you indicated the needs in the community related to your proposed project (not more than 3 A4 size paper). If applying with a partner, please clearly indicate its role in the project.
5. / Give details of the staff involved in the project, the type of employment, roles and responsibilities and how they relate to each other in terms of the management of the proposed project.
6. / Please indicate any experience (including partner's, if applicable) in carrying out projects of a similar size and nature to the one being proposed under this application (max. 300 words):
7. / Describe the measures of control you intend to adopt in order to verify the performance of internal/external staff:
8. / Name of the person responsible for the enforcement of the project:
9. / Project summary in max 1000 characters (referring on why is the project needed by describing current problems/challenges and including any relevant references to wider public plans or priorities; what is the objective of the project, that must be equivalent to an outcome of a Programme; what is the project expected to achieve by describing the project outcome(s) and mentioning any concrete targets or indicators; how will the project address these challenges by describing the project outputs – what will be produced or delivered; who is expected to benefit - target groups, etc.)
10. / Are there any assocciate partners included in the project? If so, please describe their role in the project activities.
11. / Please fill in the logical framework (add rows where needed)
Expected Outcomes of the project
(as presented in section II.2. of the Guidelines, you can chose only one Project Outcome) / Outcome Indicator
(in addition to the one presented in section II.2. of the Guidelines, please add indicators for the chosen expected outcome) / Indicator value* / Related activities
(specify activities that contribute to the related indicators) / Outputs of the activities
(including measurable values) / Time period of the activities
*If indicator values are not met, there may be the case for full or partial recovery of funds.
Project Objective I.: Empowerment of vulnerable groups
I.1. Workshops that include children and youth strenghtening their role in society / Number of children and youth included in workshops
...
... / ...
...
Project Objective II.: Democratic values, including human rights promoted
II.1. Providing tools for the improvement of life for children and youth / Number of children and youth benefiting from project activities
...
... / ...
...
12. / Explain the means of verification for measuring and determining the target indicator values i.e. how the information will be collected / monitored and how it will be verified (eg. through evaluation processes, questionnaires etc.)
13. / Please specify the expected target groups (max 2 from the list in section I.2.4. in the Guidelines)
1.
2.
Others (please specify)
14. / Describe the portion and the nature of the voluntary work in the enforcement of the project (specify number of hours and people)
15. / Describe in what way and to what extent is your project sustainable
16. / Describe in what way is your project innovative
17. / Describe the publicity measures needed for the effective implementation of the project
18. / The following cross cutting issues shall be applied in all implementation phase (these issues must be reflected in the general approach and everyday operation of the organizations - see Guidelines for pplicants in section I.2.1.): Project should make a positive contribution to gender equality, assess how the project will address the sustainable development, and ensure that the principles of good governance are integrated in the planning and implementation of the project(max. 500 words)
19. / The EEA/N Grants NGO Programme also considers the below as important horizontal concerns to be tackled in every country. Please indicate which horizontal concerns will be addressed by the proposed project
non-hate speech / tolerance and multicultural understanding
combat extremism and hate crime / Roma
combat racism and xenophobia / combat sexual harassment
combat homophobia / combat violence against women
combat anti-Semitism / combat trafficking
20. / Please describe how the proposed project aims to tackle the horizontal concerns ticked in section II.18.

Please make sure you have submitted all of the following documents!

For applicants/project coordinators:
In hard copy:
  1. Proof of registration:
  2. For associations – Extract from the Register of Associations of Croatia, or the Extract from the Register of Foreign Associations of Croatia (not older than 3 months from the date of opening the call for proposals) from which it is clear that the organisation was registered at least 3 years prior to the date of opening the Call for proposals (in accordance with the Regulations on the forms and manner of keeping the Register of associations of Croatia and Register of foreign association in Croatia – Official Gazette no. 11/02);
  3. For foundations – a copy of the Certificate of Registration of the foundation from which it is clear that the organisation was registered at least 3 years prior to the date of opening the Call for proposals;
  4. Duly filled, signed and verified Application Form (on the prescribed form);
  5. Duly filled, signed and verified Budget Form (on the prescribed form);
  6. CV of person responsible for the implementation of the project (on the prescribed form);
  7. Original Tax Administration Certificate on the debt based on public contributions of which official records are kept by the Tax Administration proving that the organisations has no outstanding debt. The certificate must be dated no longer than 30 days prior to the date of opening the Call for proposals;
  8. Copy of the Decision on non-compilation of the financial statements adopted by the governing body of the organization and a copy of the Book of income and expense for the year 2014 - for taxpayers included in simple bookkeeping;
  9. Copy of the Statut of the organisation;
  10. Relevant documentation related to VAT issue (as in I.a. 20. and 21. of the Application Form) - if applicable.
If the project is applied in partnership, the partner organisations should submit the following:
A) Domestic partner:
  1. Proof of registration of their legal status:
  2. For associations – Extract from the Register of Associations of Croatia, or the Extract from the Register of Foreign Associations of Croatia (not older than 3 months from the date of opening the call for proposals) from which it is clear that the organisation was registered at least 1 year prior to the date of opening the Call for proposals (in accordance with the Regulations on the forms and manner of keeping the Register of associations of Croatia and Register of foreign association in Croatia – Official Gazette no. 11/02);
  3. For foundations – a copy of the Certificate of Registration of the foundation from which it is clear that the organisation was registered at least 1 year prior to the date of opening the Call for proposals;
  4. Organisations of any other legal status, according to Section 4.4.1.1. of the Guidelines will be required to provide a copy of the relevant register proving the legal status;
  5. Original Tax Administration Certificate on the debt based on public contributions of which official records are kept by the Tax Administration proving that the organisations has no outstanding debt. The certificate must be dated no longer than 30 days prior to the date of opening the call for proposals;
  6. Copy of the Decision on non-compilation of the financial statements adopted by the governing body of the organization and a copy of the Book of income and expense for the year 2014 - for taxpayers included in simple bookkeeping;
  7. Financial annual report for 2013 - for profit organisations;
  8. Copy of the Statut of the organisation or equivalent;
  9. Relevant documentation related to VAT issue (as in I.b. 20. and 21. of the Application Form);
  10. Partner Declaration.

B) Foreign partners:
  1. Proof of registration of their legal status: Foreign associations or foundations and organisations of any other legal status, according to Section 4.4.1.1. of the Guidelines will be required to provide a copy of the relevant register proving the legal status or justification in case the latter requirement is not applicable for the Country involved;
  2. Copy of the Statut of the organisation or equivalent;
  3. Financial annual report for 2013 - for profit and non-profit organisations;
  4. Relevant documentation related to VAT issue (as in I.b. 20. and 21. of the Application Form)
  5. Partner Declaration.
In electronic form on CD (in open format):
  1. Filled in Application Form (on the prescribed form);
  2. Filled in Budget Form (on the prescribed form);
  3. CV of person responsible for the implementation of the project (on the prescribed form);
  4. Declarations on partnership (if applicable).

STATEMENT

I declare that the entries and the details in this Application Form are, to the best of my knowledge and belief, correct. I also confirm that the EEA/NG NGO Grants applied for is the minimum required for the project to proceed as described.

I can also confirm that I am not aware of any reason why the project may not proceed or be delayed other than those reasons declared and the commitment can be made within the timescales indicated in the Programme to which this project relates.

I acknowledge that the application will be subject to regular monitoring/auditing and undertake to keep adequate records for this purpose, in line with the instructions received from the Fund Operator.

I also declare that this project or parts of the project are not being supported through other public/EU/bilateral funding and I will abide by the principle of good governance on matters related to procurement. I also declare that I will use fair, transparent and competitive procedures in any employment contracts.

I understand that if the information included in this application is found to be not factually correct, the project may be rejected.

I understand that if the application is not complete in all relevant detail and every aspect, including this section, it may also be rejected.

Name and signature of the person responsible for the enforcement of the project / stamp / Name and signature of the person responsible for the representation of the organisation
Place and date: / , / 2015.