Optional fields which should be filled in upon necessity.
Fields which should be filled in manually by applicants.
Application Form
for
DIRECT AWARD
PART A – Project Summary
A.1 Project Identification
Programme priority / Select from drop-down listProgramme priority specific objective / Select from drop-down list (then automatically inserted in C.2.1)
Project acronym / Please specify (max. 20 characters)
Project title / Please specify (max. 150 characters)
Project number / Automatically generated
Title of the Lead partner organisation (in national language) / Automatically filled in
Title of the Lead partner organisation (in English) / Automatically filled in
Project duration / Start date / DD.MM.YYYY / No of months
End date / DD.MM.YYYY / Automatically calculated
A.2 Project Summary
Please give a short overview of the project (in the style of a press release) and describe:- the common challenge of the Programme area you are jointly tackling in your project;
- the overall objective of the project and the expected change your project will make to the current situation;
- the main project outputs you will produce and who will benefit from them;
- the approach you plan to take and why is cross border approach needed;
- what is new/original about it.
In English, Latvian, Lithuanian language (max. 1500 characters for each language)
A.3 Project Budget Summary (automatically filled in)
Project Partner / ERDF co-financing, EUR / National co-financing / Total eligible budgetPartner / Partner Abbreviation (LP_1/PP_2/PP_3/etc.) / Country / ERDF / ERDF co-financing rate / Percentage of total ERDF / Public co-financing / Private co-financing / Total co-financing
1.
Total amount for partners inside of Programme area
Total amount for partners outside the Programme area
Total
A.4 Project Main Outputs (automatically filled in based on information from WPs)
Programme output indicators / Project main output indicator targets / Measurement unit / Project main output quantification target / Project main output code / Project main outputtitle
(drop-down list of Programme output indicators corresponding to the chosen Programme priority specific objective) / Automatically calculated from the provided quantification / Automatically inserted from WP / Automatically inserted from WP / Automatically inserted from WP / Automatically inserted from WP
(drop-down list of Programme output indicators corresponding to the chosen Programme priority specific objective) / Automatically calculated from the provided quantification / Automatically inserted from WP / Automatically inserted from WP / Automatically inserted from WP / Automatically inserted from WP
PART B – Partner
B.1 Partner List
Number / Title of Project Partner / Country / Inside Programme area / Abbreviation(LP_1/PP_2/PP_3/etc.) / Role (Lead partner /project partner)
Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in
Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in
Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in
Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in
Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in / Automatically filled in
B.2 Project Partners
Lead Partner/Project PartnerProject partner number / Automatic
Project partner role in the project / Lead partner, project partner (drop-down list)
Title of the organisation in national language / Please specify (max. 200 characters)
Title of the organisation in English / Please specify (max. 200 characters)
Department of the organisation / If relevant
ADRRESS
NUTS code / number and name of the region and country where the organisation is located – drop-down list
Address / Please specify street, postcode, city, town, district, county, homepage
Legal and Financial Information
Legal status of the project partner / (drop-down pre-defined list)
Programme co-financing source / ERDF (drop-down list)
Co-financing rate / Please specify
National co-financing source / Public/private (drop-down pre-defined list)
VAT number / Please specify
Is your organisation entitled to recover VAT based on national legislation for the activities implemented in the project? / No/yes/partly
(drop-down list) / If partly explain how.
Registration number of the organisation / Please specify
Authorised representative
Authorised representative / Please specify contact details – name, surname, e-mail address, telephone, mobile telephone
Contact person
Contact person / Please specify contact details – name, surname, e-mail address, telephone, mobile telephone
AdDITIONAL INFORMATION, IF RELEVANT
Please specify additional information about project partner, if relevant. / Please specify (max. 2000 characters)
PART C – Project description
C.2 Project Focus
Programme Priority Specific Objective / Programme Result IndicatorSelect one Programme priority specific objective your project will contribute to. / Select Programme result indicator(s) your project will contribute to.
(automatically inserted from A.1) / (drop-down list of Programme result indicators corresponding to the selected Programme priority specific objective)
Project overall objective / EXPECTED Project results
What is the overall objective of the project and how does it link to the Programme objective?
Specify one project main objective and describe its contribution to the Programme priority specific objective. / What are the project results and how do they link to the Programme result indicator?
Specify one or more project results and describe their contribution to the Programme result indicator.
Please insert project overall objective (max. 1000 characters) / Please insert project results (max. 2000 characters)
Project specific objectives
Which are the specific objectives the project will be working towards?
Define max. 3 project specific objectives.
Title of the project specific objective / Explanation of the project specific objective
Please specify (max. 1000 characters) / Please specify (max. 2000 characters)
Durability of project main outputs
How will the project ensure that project main outputs and results have a lasting effect beyond project duration?
Please describe concrete measures (including institutional structures, financial resources etc.) taken during and after project implementation to ensure and/or strengthen the durability of the project main outputs and results. If relevant, explain who will be responsible and/or who will be the owner of results and project main outputs.
Please specify (max. 4000 characters)
PART D – Work plan
D.1 Work Package List
WP title / WP start month / WP end monthWP Preparation / Automatic from WP / Automatic from WP
WP Management / Automatic from WP / Automatic from WP
WP Implementation / Automatic from WP / Automatic from WP
WP Investment / Automatic from WP / Automatic from WP
WP Communication / Automatic from WP / Automatic from WP
D.2 Timeline (automatically generated)
Work packages and activities / Month 1 / Month 2 / Month3 / Month 4 / Month 5 / Month 6 / Month 7 / Month 8 / Month 9
WP M Management / A.M.1
D.M.1.1
WP T1 title / A.T1.1
D.T1.1.1
WP I1 title
WPC Communication
Etc
WP Nr / WP title / WP start month / WP end month / WP budget
0 / Preparation P / Please specify MM.YYYY / Please specify MM.YYYY / Automatically filled in from part E or F
Partners’ involvement
Involved project partners / Drop-down list
Summary description of activities carried out and contribution of each partner.
Please specify (max. 2000 characters)
WP Nr / WP title / WP start month / WP end month / WP budget
1 / Management M / Automatic from activities / Automatic from activities / Automatically filled in from part E or F
Partners’ involvement
WP responsible partner / Lead partner – automatically inserted from Part B - Partners
Involved project partners / Drop-down list
Description
Describe how the management on the strategic and operational level will be carried out in the project, specifically:
- structure, responsibilities and procedures for the day-to-day management and coordination;
- communication within the partnership;
- reporting;
- indication whether project management will be subcontracted;
- explanation how the equipment for project management purpose will be used and by which project partners.
(max. 2000 characters)
Please describe activities and deliverables within the work package.
Activity A.M.1
(automatic numbering) / Activity title
Please specify (max. 500 characters) / Start date
Please specify
(MM.YYYY) / End date
Please specify
(MM.YYYY)
Activity description
Please specify (max. 4000 characters)
Deliverable D.M.1.1
(automatic numbering) / Deliverable title (max. 500 characters)
Please specify / Target value
Please specify / Delivery month
Please specify (MM.YYYY)
Deliverable description
Please specify (max. 4000 characters)
WP Nr / WP title / WP start month / WP end month / WP budget
2-3 / Implementation T1 (please specify title from activities) / Automatic from activities / Automatic from activities / Automatically filled in from part E or F
Partners’ involvement
WP responsible partner / Drop-down list
Involved project partners / Drop-down list
Summary implementation
Please provide description and objective of the work package including explanation of how will partners be involved (who will do what).
Please specify (max. 2000 characters)
Project main outputs
Please describe project main outputs that will be delivered based on the activities carried out in this work package. For each project main output a Programme output indicator should be chosen. Please note that they need to have the same measurement unit.
Project main outputs / Describe your project main output / Project main output quantity / Delivery date / Choose a Programme output indicator to which the project main output will contribute
Output O.T1.1
(automatic numbering) / Project main output title (max. 1000 characters) / Please specify (max. 2000 characters) / Please specify number / Please specify MM.YYYY / Drop-down list
Output O.T1.2
(automatic numbering) / Project main output title (max. 1000 characters) / Please specify (max. 2000 characters) / Please specify number / Please specify MM.YYYY / Drop-down list
Output O.T1.3 (automatic numbering) / Project main output title (max. 1000 characters) / Please specify (max. 2000 characters) / Please specify number / Please specify MM.YYYY / Drop-down list
Target groups
Who will use the project main outputs delivered in this work package? / Drop-down list of pre-defined target groups (multiple selection possible)
How will you involve target groups (and other stakeholders) in the development of the project main outputs? / Please specify (max. 1600 characters)
Please describe activities and deliverables within the work package.
Activity A.T1.1
(automatic numbering) / Activity title (max. 500 characters)
Please specify / Start date
Please specify (MM.YYYY) / End date
Please specify (MM.YYYY)
Activity description
Please specify (max. 4000 characters)
Deliverable D.T1.1.1
(automatic numbering) / Deliverable title
Please specify (max.500 characters) / Target value
Please specify / Delivery month
Please specify
(MM.YYYY)
Deliverable description
Please specify (max. 2000 characters)
WP Nr / WP title / WP start month / WP end month / WP budget
4 / Investment I1 (please specify title of investment) / Automatic from activities / Automatic from activities / Automatically filled in from part E or F
Partners’ involvement
WP responsible partner / Drop-down list
Involved project partners / Drop-down list
Summary Investment
Please provide description and objective of the work package including explanation of how will partners be involved (who will do what).
Investment description including technical specification and quantification.
Please specify (max. 2000 characters)
Justification
Explain the need for investment to achieve project objectives and results.
Describe clearly the cross border relevance of the investment.
Describe who is benefiting (e.g. partners, regions, end-users etc.) from this investment and in what way.
Please specify (max. 1500 characters)
Location of the investment
Location of the physical investment; if possible a concrete address where the investment will take place / Drop-down list (NUTS3 codes + whole Programme area)
Please specify (max. 500 characters)
Risks associated with the investment
Description of the risks associated with the investment (if any).
Please specify, if relevant (max. 1800 characters)
Investment documentation
Please list all relevant technical documentation needed for the investment according to the respective national legislation and attach it to this application form or submit to JS according to Part I section 6.1 of the Programme manual.
Please specify (max. 1800 characters)
Ownership
Who owns the site where the investment is located?
Are there ownership and/or usage rights or lease rights for lease period covering planned project duration and according to requirements set in section 7.4. “Closure and durability of the project results” subsection “Durability and ownership of project results” of the Programme manual?
Who will retain ownership of the investment at the end of the project?
Who will take care of maintenance of the investment? How will this be done?
Please specify (max. 1800 characters)
Project main outputs
Please describe project main outputs that will be delivered based on the activities carried out in this work package. For each project main output a Programme output indicator should be chosen. Please note that they need to have the same measurement unit.
Project main outputs / Describe your project main output / Project main output quantity / Delivery date / Choose a Programme output indicator to which the project main output will contribute
Output O.I1.1
(automatic numbering) / Project main output title (max. 1000 characters) / Please specify (max. 2000 characters) / Please specify number / Please specify MM.YYYY / Drop-down list
Output O.I1.2
(automatic numbering) / Project main output title (max. 1000 characters) / Please specify (max. 2000 characters) / Please specify number / Please specify MM.YYYY / Drop-down list
Output O.I1.3 (automatic numbering) / Project main output title (max. 1000 characters) / Please specify (max. 2000 characters) / Please specify number / Please specify MM.YYYY / Drop-down list
Target groups
Who will use the project main outputs delivered in this work package? / Drop-down list of pre-defined target groups (multiple selection possible)
How will you involve target groups (and other stakeholders) in the development of the project main outputs? / Please specify (max. 1600 characters)
Please describe activities and deliverables within the work package.
Activity A.T1.1 / Activity title
Please specify (max. 500 characters) / Start date
Please specify (MM.YYYY) / End date
Please specify (MM.YYYY)
Activity description
Please specify (max. 4000 characters)
Deliverable D I1.1.1. / Deliverable title
Please specify (max. 500 characters) / Target value
Please specify / Delivery month
Please specify (MM.YYYY)
Deliverable description
Please specify (max. 4000 characters)
WP Nr / WP title / WP start month / WP end month / WP budget
6 / Communication C / Automatic from activities / Automatic from activities / Automatically filled in from part E or F
Partners’ involvement
WP responsible partner / Drop-down list
Involved project partners / Drop-down list
Summary
Please provide summary description of activities carried out and contribution of each partner.
Please specify (max. 2000 characters)
Project specific objectives / Communication objectives
What can communications do to reach a specific project objective? / Approach/Tactics
How do you plan to reach your target groups?
Specific objective 1
(Pre-filled from C.2.1) / Possibility to fill in 0 - 2 communication objectives per project objective / Please specify (max. 800 characters)
Specific objective 2
(Pre-filled from C.2.1) / Possibility to fill in 0 - 2 communication objectives per project objective / Please specify (max. 800 characters)
Specific objective 3
(Pre-filled from C.2.1) / Possibility to fill in 0 - 2 communication objectives per project objective / Please specify (max. 800 characters)
Please describe activities and deliverables within the work package.
Activity A.C.1 / Activity title
Please choose from a drop-down list / Start date
Please specify (MM.YYYY) / End date
Please specify (MM.YYYY)
Activity description
Please specify (max. 4000 characters)
Deliverable
D C.1.1. / Deliverable title and description
Please specify (max. 500 characters) / Target value
Please specify / Delivery month
Please specify (MM.YYYY)
Deliverable description
Please specify (max. 4000 characters)
D.3 Target Groups