Approved by the Minister of Social Affairs October31, 2013 with the decree no.122

“Guidelines for grant applicant responding to the fund for bilateral relations

under Norwegian Financial Mechanism 2009-2014

programme “Public Health Initiatives”

Tobecompletedbytherecipient
Application no. / Click here to enter text.

NORWEGIAN FINANCIAL MECHANISM 2009-2014

PROGRAMME “PUBLIC HEALTH INITIATIVES”

APPLICATION FORM OF THE FUND FOR BILATERAL RELATIONS

  1. General information

The objective of the Norwegian Financial Mechanism 2009-2014 (Norwegian FM) programme “Public Health Initiatives” is improved public health and reduced health inequalities in health services. The main activities of the programme are related to improvement of mental health services for children, reduction of risk-taking reproductive behaviour and promotion of healthy behaviour and lifestyle.

The aim of the fund for bilateral relations (FBR) is to support and facilitate:

  • search for project partners from donor country Norway and development of such partnerships;
  • operating as cooperation network, exchange, sharing and forwarding of the knowledge, technologies, experience and best practices between the project promoters and Norwegian institutions.

The given form will be used in the evaluation process under the FBR of the Norwegian FM programme „Public Health Initiatives.” We request that all the information of the FBR applicationissubmitted to the Ministry of Social Affairs by the date and time given in the Guidelines and web-page The form must be filled inEnglish.

Before filling and submitting the application form we ask that you carefully read the Guidelines for the FBR as well as the Programme Agreement of the „Public Health Initiatives“ programme.

All the above mentioned documents are available on the programme’s website at

  1. Submission and general data

B.1Submissiondata
Project title / Clickheretoentertext.
Deadline for submission / Continuousbasisuntilthe1st of November, 2016 at 12:00 PM (EET)
  1. Applicant information

C.1 Applicant organization
Name of organization (include abbreviation, if applicable) / Click here to enter text. /
Legal status / Click here to enter text. /
Reg. number / Click here to enter text. /
Address / Click here to enter text. /
Zip-code / Click here to enter text. / City/town
/ Click here to enter text. /
Country / Estonia
Phone / Click here to enter text. /
E-mail / Click here to enter text. /
Homepage / Click here to enter text.
C.1.1 Person authorized to sign theproject contract
First name / Clickheretoentertext.
Last name / Clickheretoentertext.
Position / Clickheretoentertext.
Phone / Clickheretoentertext.
E-mail / Clickheretoentertext.
C.1.2 Contact person (applicant)
☐ / Check here if same as C.1.1 – Person authorized to sign the project contract and continue with section C.2
First name / Clickheretoentertext.
Last name / Clickheretoentertext.
Position / Clickheretoentertext.
Phone / Clickheretoentertext.
E-mail / Clickheretoentertext.
I allowtousecontactperson’s e-mail addressforpassinginformation and submittingdocuments. / ☐YES / ☐NO
C.2Background of the applicant organization
Please describe the applicant organization's field of activity in general and main activities and highlight the main facts that support the organizations competence and ability to execute the proposed project (including previous experience with similar activities experience in the field, etc.).

Click here to enter text.

C.3 Project Partner (fill in if relevant)
Name of organization (include abbreviation, if applicable) / Clickheretoentertext.
Legal status / Clickheretoentertext.
Reg. number / Clickheretoentertext.
Address / Clickheretoentertext.
Zip-code / Clickheretoentertext. / City/town / Clickheretoentertext.
Country / Clickheretoentertext.
Phone / Clickheretoentertext.
E-mail / Clickheretoentertext.
Homepage / Clickheretoentertext.
C.3.1 Person authorized to sign the contract with the applicant (project partner)
☐Mr
☐Mrs/Ms / First name / Clickheretoentertext.
Last name / Clickheretoentertext.
Position / Click here to enter text.
Phone / Click here to enter text.
E-mail / Click here to enter text.
C.3.2 ContactPerson (Project partner)
☐ / Check here if same as C.3.1 – Person authorized to sign the contract(project partner) and continue with sectionD – Applicant's professional background and expertize
☐Mr
☐Mrs/Ms / First name / Clickheretoentertext.
Last name / Clickheretoentertext.
Position / Clickheretoentertext.
Phone / Clickheretoentertext.
E-mail / Clickheretoentertext.
C.2 Background of the partner organization
Please describe the partner organization's field of activity in general and main activities and highlight the main facts that support the partner organizations competence and ability to execute the proposed project (including previous experience with similar activities and experience in the field, etc.).

If in addition to the partner mentioned above, there are other entities involved with the project that qualify as partners, please provide their information as exemplified in sections C.3, C.3.1 and C.3.2 to the end of section C.

  1. DONOR PROJECT PARTNER

Name of organization (include abbreviation, if applicable) / Click here to enter text. /
Legal status / Click here to enter text.
Reg. number / Click here to enter text. /
Address / Click here to enter text. /
Zip-code / Click here to enter text. / City/town / Click here to enter text. /
Country / Kingdom of Norway
Homepage / Click here to enter text. /
Contact person[1] / Click here to enter text. /
Phone / Click here to enter text. /
E-mail / Click here to enter text. /
D.1Background of the donor project partner
Please describe donor project partner organization’s main activities and competence in the field and role in the project.

Click here to enter text

  1. PROPOSAL FOR THE FUND FOR BILATERAL RELATIONS

E.1 Overview of the project. Please describe the main aim of the project and how it will affect the objectives of the „Public Health Initiatives” programme.

Click here to enter text.

E.2Objective of the bilateral relations proposal
Please describe theobjectives and expected results of the bilateral relationsproposal. Please indicate how using the FBR will support the project proposal or project implementation.

Click here to enter text.

E.3Activities of the bilateral relations proposal
Please describe planned activities. Indicate duration and preliminary schedule, participants, tasks and expected results of the activities.

Click here to enter text

E.4Importance of the cooperation
Please describe the main advantages that your institution could offer to a potential donor project partner and indicate benefit of partnership between the organizations.

Click here to enter text.

  1. BUDGET OF THE BILATERAL RELATIONS PROPOSAL

Please name the categories of expenses and prices (conference fee, consultant fee, travelling expenses etc.)
Category of Expenses / Unit of measurement (hour, person, etc.) / Unit price / Total
  1. (please insert additional rows if needed)

  1. Total cost of the project (100%)

  1. Grant from bilateral relations fund (Norwegian Mechanism)

  1. CONFIRMATION

To be completed by the person authorised to enter into legally binding commitments on behalf of the applicant.

I hereby request a grant from the fund of bilateral relations under the Norwegian Financial Mechanism 2009-2014 programme “Public Health Initiatives” in the amount of Click here to enter amount EUR to implement the action covered by this grant application.

I certify that all information contained in this application is correct to the best of my knowledge andI am aware of the content of other relevant documents (“Project Partner Statement”) of the application form.

I certify that the applicant organization has the financial and managerial capability to execute the proposed project successfully.

I certify that the applicant organization is not in any of the following situations:

  1. bankrupt or being wound up, have their affairs being administered by the courts, have entered into an arrangement with creditors, have suspended business activities, are the subject of proceedings concerning those matters, or are in any analogous situation arising from a similar procedure provided for in national legislation or regulations;
  2. has been convicted of an offence concerning their professional conduct by a judgment which has the force of res judicata;
  3. has been the subject of a judgment which has the force of res judicata for fraud, corruption, involvement in a criminal organisation or money laundering;
  4. has been in serious breach of contract or has failed to comply with following another procurement procedure or grant award procedure;
  5. not in compliance with their obligations relating to the payment of social security contributions or the payment of taxes in accordance with the legal provisions of the Estonian Republic.

I certify that the applicant organisation or other organisation and people involved with this initiative:

  1. are not in a situation where there is a conflict of interests[2];
  2. have not presented false information;
  3. have not applied for any funding for the same initiative from other grant programs, EU programs, or from the Estonian state budget.

By signing this application form, I accept all the conditions set out in the Guidelinesfor grant applicantrespondingtothefundforbilateralrelationsunderNorwegianFinancialMechanism 2009-2014 Programme „PublicHealthInitiatives”.

Full legal name:Click here to enter text.

Position:Click here to enter text.

Signature:Click here to enter text.

Date:Click here to pick a date

The application with all its annexes must be sent electronically to the Ministry of Social Affairs.
E-mail:

P.S! Submitting application documentation electronically please make sure that the format of downloaded forms is maintained.

Ministry of SocialAffairs
Gonsiori 29, 15027 Tallinn

[1]Ministry of Social Affairs will contact with the partner before making a decision about the funding.

[2]A conflict of interest is a situation in which a relationship between an applicant and an official from the Ministry of Social Affairs and/or an evaluator may lead to a conflict between either party’s professional and private interests in which the private interests of an official or evaluator may influence the impartiality and objectivity and the responsibility related to that.