To Be Filled in by the Executive Agency

8/14/2019 To Be Filled in by the Executive Agency

1/20

To be filled in by the Executive Agency

Application reference number

Postmark / Date of receipt

'Youth in Action' Programme

Action 4.4

Youth support systems: Projects encouraging creativity and innovationin the youth sector

Call for Proposals EACEA/12/09

APPLICATION FORM

CLOSING DATE FOR SUBMISSION: 30.09.2009(as per postmark

or the date of the deposit slip in case of dispatch by express courier)

Applications bearing a postmark after this date will not be considered.

Applications must be sent by post bearing the original signature of the legal representative of the applicantorganisation and the original signatures of the partners.

Handwritten applications and/or sent by fax ore-mail will not be accepted.


2/20

Please fill in all relevant sections of this application. It is compulsory to annex ALL documents requested in the check list.Please consult the Call for proposals EACEA/12/09 to find all the information you need to lead your project and to fill in this application form.

Part I. Identification of the applicant organisation

A. Details of the applicant organisation1

Full name Acronym:

Registered address Street: N:

Postcode City

Region Country

Telephone Fax

Website

Person authorised to represent the organisation in legally binding agreements (legal representative)

Surname (Ms/Mr) First name

Position/function Email

Person in charge of the project (contact person)



Telephone Fax

B. Profile of the applicant2

Legal status Private Public

Type Non-profit NGO National Youth Council

Activity level Local Regional National European/International

Please give a short presentation of your organisation (aims and regular activities, membership in other structures, specificexpertise, staff, possible involvement of young people under 30 in the organisation's structure and activities, etc.) and explain yourmotivation to carryout the proposed project.

1

Please

download and fill in the legal entity identification form from the European Commissions website:http://ec.europa.eu/budget/execution/legal_entities_en.htm

2Please join relevant "Articles of association" (statutes): document that sets out the structure, purpose and operating parameters of

your organisation

'Youth in Action' Programme 2009_Action 4.4: Creativity & Innovation APPLICATION FORM Page 2
http://ec.europa.eu/budget/execution/legal_entities_en.htmhttp://ec.europa.eu/budget/execution/legal_entities_en.htm


3/20

C. Operationalcapacity

Professional competences and qualifications:

Please describe the know-how of your organisation in the fields covered by the Call for proposals (see point 2.2 of the

Applicants' Guidelines). Such experience is to be illustrated by means of a list of projects already implemented (the past twoyears only) in the relevant fields.

Please also mention the different products realised by these projects, i.e. publications, website, etc. Please give precise

references.

Please attach a copy of the Curriculum Vitae of the person responsible for the general coordination/implementation of the

action (contact person).

D. European Community funding obtained the last two financial yearsApplica

ntPartner Agreement n

Programme/Action

Project titleAmount in

E. Has your organisation submitted, or does it intend to submit, a grant application forthis project or any other project to other Actions of the 'Youth in Action' Programme orto (an)other European Community Programme(s) in 2009?

NO YES (please specify)

Application Project

submitted

intendto

submit

thesame

another

'Youth inAction'

Programme(please specify

Action)

Other EC Programme(please specify)

Amount in

Grantdecision

taken

YesNotyet



4/20

F. Declaration on honour

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

I, the undersigned, certify that all information contained in this application, including project description, is correct tothe best of my knowledge and am aware of the content of the annexes to the application form.

I confirm that my organisation/group has the financial and operational capacity to complete the proposed project.

I confirm that my organisation/group has taken the appropriate measures to ensure the protection and safety ofparticipants involved in the project.

I take note that under the provisions of the Financial Regulation applicable to the general budget of the EuropeanCommunities, grants may not be awarded to applicants who are in any of the following situations:

(a) if they are bankrupt or being wound up, are having their affairs administered by the courts, have entered into anarrangement with creditors, have suspended business activities, are the subject of proceedings concerningthose matters, or are in any analogous situation arising from a similar procedure provided for in nationallegislation or regulations;

(b) if they have been convicted of an offence concerning their professional conduct by a judgment which has theforce ofres judicata;

(c) if they have been guilty of grave professional misconduct proven by any means which the contracting authoritycan justify;

(d) if they have not fulfilled obligations relating to the payment of social security contributions or the payment oftaxes in accordance with the legal provisions of the country in which they are established or with those of thecountry of the contracting authority or those of the country where the contract is to be performed;

(e) if they have been the subject of a judgment which has the force ofres judicata for fraud, corruption, involvementin a criminal organisation or any other illegal activity detrimental to the Communities' financial interests;

(f) if following another procurement procedure or grant award procedure financed by the Community budget, theyhave been declared to be in serious breach of contract for failure to comply with their contractual obligations;

(g) if, on the date of the grant award procedure, they are subject to a conflict of interest;

(h) if, on the date of the grant award procedure, they are guilty of misrepresentation in supplying the informationrequired by the contracting authority as a condition of participation in the grant award procedure or fail to supplythis information.

I confirm that neither I nor the organisation/group for which I am acting as legal representative are in any of thesituations described above, and am aware that the penalties set out in the Financial Regulation may be applied in thecase of a false declaration.

In the event that my grant application is successful, I authorise the Commission/the Agency to publish on its internetsite or in any other appropriate medium:

The name and address of the beneficiary of the grant;

The subject of the grant;

The amount awarded and the rate of funding of the costs of the approved work programme.

Applicantorganisation:

Legal representative:(Mr/Ms Surname, First name)

Stamp(if

available)

Position/function inthe organisation:

Date: (dd/mm/yyyy)

Signature



5/20

Part II. Identification of the partners

To be filled in by each partner organisation

A. Details of the partner organisation

Full name Acronym:

Registered address Street: N:

Postcode City

Region Country

Telephone Fax

Website

Person authorised to represent the organisation in legally binding agreements (Legal representative)



Person in charge of the project (contact person)



Telephone Fax

B. Profile of the partner

Legal status Private Public

Type Non-profit NGO National Youth Council

Activity level Local Regional National European/International

Please give a short presentation of your organisation (aims and regular activities, membership in other structures, specificexpertise, staff, possible involvement of young people under 30 in the organisation's structure and activities, etc.) and describe yourcompetencies and motivation to cooperate in the implementation of the project.



6/20

C. Mandate(s)

To be signed by the persons authorised to enter into legally binding commitments on behalf of theapplicant, respectively each partner

MANDATE

[full official name of the organisation]

[official address in full]

[ISO-code country Postal code CITY],

(the partner), represented for the purposes of signature of this mandate by [surname, first name and function]

of the one part,

and

[full official name of the organisation]

[official address in full][ISO-code country Postal code CITY],

(the applicant), represented for the purposes of signature of this mandate by [surname, first name and function]

HAVE AGREED

for the purposes of the implementation of the action entitled

[project title]("the action");

the following:

1. The partner grants power of attorney to the applicant, to act in its name and for its account in submitting the aboveproject and, if selected for a grant award, signing an agreement and its possible subsequent riders with the

Education, Audiovisual and Culture Executive Agency. Accordingly, the partner hereby mandates the applicant to

take full legal responsibility for the implementation of the above project and related agreement with the Agency.

2. The partner hereby confirms having taken careful note of all the provisions of the relevant call for proposals andmodel grant agreement, in particular of all provisions affecting the partner and the applicant (Article I.3). The

partner acknowledges that, by virtue of this mandate, the applicant alone is entitled to receive the funds from theAgency and distribute the amounts corresponding to the participation of each organisation in the project as laid

down in Article I.3.1h and Article I.7.3 of the proposed agreement.

3. The partner hereby agrees to do everything in his power to carry out properly the actions assigned to him acting onhis own responsibility, and certifies that it has the operational and financial capacity to participate in the action

mentioned above.

4. The partner hereby agrees to do everything in his power to help the applicant fulfil its obligations under theproposed grant agreement. In particular, the partner hereby agrees to provide to the applicant whatever documents

or information may be required under the terms and conditions of the grant agreement, as soon as possible after

receiving the request from the applicant.

5. The provisions of this mandate, shall take precedence over any other agreement between the partner and theapplicant, which may have an effect on the implementation of the agreement between the co-ordinator and theEducation, Audiovisual and Culture Executive Agency.

6. Subject to selection for a grant award, a copy of this mandate shall be annexed to the agreement signed between theapplicant and the Agency and shall form an integral part of it.

SIGNATURES

For the partner For the applicant

[surname/first name] , [surname/first name] ,Function: Function:Done at , Date: . . / . . / . . . . Done at , Date: . . / . . / . . . .



7/20

In triplicate in English



8/20

Part III. Project identification and summary

A. Title of the project

Please give a short title to the project.

B. Duration of the project

Please indicate the total duration of the project from preparation to evaluation and also the venue(s) where the project activities wil lbe carried out.

Start date of the project:(date of first costs incurred)

. / . / End date of the project:(date of last costs incurred)

. / . / Total

duration(in months)

Venue(s):

C. Objectives

Please tick the box(es) corresponding to the Objective(s) addressed by the project

(1) Promote young peoples active citizenship in general and their European citizenship in particular

(2) Develop solidarity and promote tolerance among young people

(3) Foster mutual understanding between young people in different countries

(4) Promote European cooperation in the youth sector

(5) Contribute to developing the quality of support systems for youth activities and the capabilities ofcivil society organisations in the youth sector

D. Priority themes

Please tick the box (one only) corresponding to the Theme addressed by the project

(1) Media literacy of young people

(2) e-youth work

E. Activities

Please tick the box(es) corresponding to theActivity(ies) addressed by the project.

Virtual activities using web tools Awareness raising campaigns

Seminars Networking activities

Training courses Exchange of best practices

Creation and production of innovative Other (please specify):audiovisual and multimedia tools _____________________________

_____________________________

F. Creativity and Innovation

Please tick the box(es) corresponding to the Creative/Innovative element of your project

Content Conceptual Other (please specify):

Methodology Technological _____________________________

_____________________________



9/20

G. Project partners (including the applicant) and related number of participants

Organisation nameLegal status

&Type

Country

Number ofyoung

people/youthworkers

Number oftrainers,

facilitators, staff

n 1

n 2

n 3

n 4

n 5

n 6

Total n:

H. Summary of the project

Please, give a brief summary of your project (approximately 2.000 characters). Please note that this section may be used forpublication. Therefore be accurate and include:

Objectives (including priority theme chosen)

Activities foreseen

Venue(s)

Number of artici ants

Creative/Innovative element of your project

Concise description of the outputs (tangible results)

Dissemination and exploitation strategy

Impact envisaged

The summary should be written in English, French or German, regardless of which language you use to fill in the rest of thisapplication. Please be concise and clear.



10/20

Part IV. Project implementation

The points below are intended to serve as a guide for your description of the proposed activities. The information that is requested willbe very important in the selection process, and later for the monitoring and evaluation of the project.

If more space is needed, please extend boxes

A. Objectives of the project

Please describe: the General Objectives of the Youth in Action Programme targeted by your project;

how the project is targeting the Specific Objective (creative and innovative ability of young people) of this call for proposals;

how you are going to address the Priority Theme (media literacy of young people / e-youth work) you have chosen;

the expected results and the target group(s) of the project.

B. Creative/Innovative aspect

Please explain in detail:

what are the creative (beyond originality) characteristics of your project;

why your project is genuinely innovative.

C. Work programme

Please describe:

the working methods envisaged;

the activities foreseen throughout the action for its implementation, including preparatory and evaluation activities;

the sharing of tasks within the applicant organisation and among the partners;

how you intend to organise and co-ordinate the activities with regard to the scale of your project;

how you intend to ensure the quality and coherence of the project work programme;

how the planned activities and working methods will contribute to the process of non-formal learning and to the promotion of

social, professional and personal development of young people involved in the project.

Please identify, where relevant, specific tasks that will be sub-contracted to bodies other than the applicant organisation and/orpartners.



11/20


12/20

D. Multiplying effect and sustainable impact of the project

Please describe:

the multiplier effect of the project for the development of youth work, youth policies and youth empowerment;

the impact that the planned activities will have on the young people involved;

the impact in a longer term perspective on youth work, youth policies and/or the capacity-building and leadership development

of the youth organisations/structures;

the impact of the project on the development of sustainable partnerships and networking among youth organisations.

Please also identify indicators which could help you measuring the impact of the project.

Please indicate the estimated number of young people indirectly benefiting from the project and explain how this willbe achieved.

E. Quality of the partnership

Please describe:

the profile of your partners, focusing particularly on their experience in the field of youth; the reasons why they are chosen as partners, as well as their motivation to participate;

the division of tasks among the partnership and the role of each partner in the cooperation.

You should illustrate your response with specific examples of actions.

Please also state what kind of complementarity your partnership is based upon.

Finally, explain briefly who are the main actors of the project, for each partner, describing their specific skills.

F. Involvement of participants

Please explain:

how the participants will be selected;

how they will be involved in the project;

Please point up the activities attended to and run by young people.

how will young people be involved in each stage of the project.

Does your project involve young people with fewer opportunities? Yes No

If so, please tick the situation(s) they face and explain how this will be achieved.

Geographical obstacles Health problems Economic obstacles Disability

Educational difficulties Social obstacles Cultural differences Other: _________________



13/20

G. Dissemination and exploitation of results

Please describe:

the tangible results you intent to achieve;

the products you plan to develop during the project.

Please give a detailed description of the strategy defined and the measures planned in view to spread and exploit the results of theproject.

H. Visibility

Apart from the compulsory use of the 'Youth in Action' Programme logo (Point 11 - Publicity of the Applicants' Guidelines), pleasedescribe:

how you will ensure the broad visibility of your activities and of the project as a whole;

how your project will provide clear promotional added value for the 'Youth in Action' Programme.

I. Evaluation and follow-up

Please describe:

how you will ensure the evaluation and follow-up of the project.

Please provide details of:

the evaluation activities to be performed during the project implementation;

your risk assessment as regards implementation of the project (qualitative and quantitative values) and corrective measures

planned;

the evaluation activities at the end of the project.

J. Quantitative information on the different actors involved in the project

EU27Other Programme

countriesTotal

Number of partners involved in the project

Number of countries involved in the project

Number of youth workers directly involved in the project

Number of young people directly involved in the project

Number of young people with fewer opportunities involved in the project



14/20

Part V. ESTIMATED BUDGET

For information on funding rules and eligibility of costs please consult the text of the Call for proposals.Please note that the Executive Agency has the right to revise the amounts (including the EC grant requested) on the basis of the rules

set out in the Call for proposals

All figures in EURO -

EXPENDITURE

Direct costs Total(in cash)

(1) Costs directly linked to the implementation of project activities

(2) Production / Translation / Dissemination / Information costs

(3) Information and Communication Technology (ICT) costs

(4) Travel, board and lodging costs

(5)Personnel costs(up to 30% of other direct eligible costs, i.e. budget chapters 1 + 2 + 3 + 4)

Sub-total direct costs

(6)Indirect costs

(up to 7% of all direct eligible costs, i.e. budget chapters 1 + 2 + 3 + 4 + 5)A. TOTAL EXPENDITURE (without contributions in kind)

B. Contributions in kind3

TOTAL A + B

INCOME

Name, descriptionTotal

(in cash)

(1) National/regional/local institutions

(2) Other Community funding for this project

(3) Private donors

(4) Other resources

(5) Own resources (including partners')

(6)EC grant requested from the 'Youth in Action' Programme(maximum 65% of A: Expenditure)

A. TOTAL INCOME (without contributions in kind)

B. Contributions in kind3

TOTAL A + B

Applicant

Legal representative:(Mr/Ms Surname, First name)

Stamp(if

available)

Position in the

Date:(dd/mm/yyyy)

Signature

3 Total B should equal the sum of contributions in kind claimed under each budget heading (see 'Detailed calculation of estimatedcosts' hereafter). Please also note that the same figures should be reported in both estimated expenditure and estimated incomesections. Contributions in kind shall not exceed 10% of the project's budget.



15/20

Detailed calculation of estimated costs

Please note that each item embedded in the budget must be clearly identified and specified

1. Costs directly linked to the implementation of project activities

Where applicable, please separate clearly the different phases of your project (e.g. preparation, activity, follow-up, etc.) in thespecification column.

a. Insurance and visa costs

Organisation Activity Specification

Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (a)

b. Rental of rooms for meetings, conferences, other events, etc.


Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (b)

c. Interpretation costs (including travel, accommodation and fees)

Activity

Languages

from into

Nr ofinterpreters

Nr ofdays

Amountper day

Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (c)



16/20

d. Hire of booths for interpretation (including equipment)

Activity SpecificationNr ofdays

Amountper day

Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (d)

e. Fees for external speakers

ActivityNr of

speakersNr ofdays

Amountper day

Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (e)

f. Other

Please specify other possible costs.


Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (f)

TOTAL COSTS DIRECTLY LINKED TO THE IMPLEMENTATION OFPROJECT ACTIVITIES



17/20

2. Production / Translation / Dissemination / Information costs

Please indicate costs of production and distribution of information, of documents and materials to be published (CD-ROM, video,books, leaflets, etc.) including the estimated number of copies needed.

a. Production

SpecificationNr of

copiesUnit price

Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (a)

b. Translation

Specification

Languages

from into

Nr ofpages

Price perpage

Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (b)

c. Dissemination / Information costs

Specification Nr of items Unit price

Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (c)

TOTAL PRODUCTION / TRANSLATION / DISSEMINATION / INFORMATIONCOSTS



18/20

3. Information and Communication Technology (ICT) costs

Computer and audiovisual equipment purchased or rented during the project lifetime

The depreciation rule applies to any purchase above EUR 500

Activity SpecificationCost

(purchasevalue)

Depreciationrate

Degree ofuse in the

project(%)

Costs

in cash(a)

in kind(b)

Total(a+b)

TOTAL ICT COSTS

4. Travel, board and lodging costs

a. Travel costs

Please note that only cheapest means of transport and fares are subject to reimbursement (APEX airfare, 2nd class train ticket, etc.).In case of travel by private car a flat reimbursement of EUR 0,22 /km applies.

The number of persons consists of the total of young people/youth workers, trainers and support staff participating in each activity.

Activity OrganisationNr of

personsOrigin Destination

Means oftransport

Costs

in cash(a)

in kind(b)

Total(a+b)

Sub-total (a)

b. Board and lodging costs (including local transport)

Please keep in mind that subsistence (accommodation and daily allowance) costs should be in line with the usual practice of yourorganisation and where applicable of your partners. If these costs are considered to be extravagant, they will be reviewed andcapped at the scales annually approved by the European Commission (see table of DAILY SUBSISTENCE ALLOWANCES).

The number of persons consists of the total of young people/youth workers, trainers and support staff participating in each activity.

Activity Organisation Place of stayNr of

personsTotal nrof days

Averagecost per

day

Costs(Total nr of days * Average cost per day)

in cash

(a)

in kind

(b)

Total

(a+b)

Sub-total (b)

TOTAL TRAVEL, BOARD AND LODGING COSTS



19/20

5. Personnel costs [up to 30% of other direct eligible costs (in cash), i.e. budget chapters 1 + 2 + 3 + 4]

Please indicate the personnel costs directly linked to the activity (including names, functions and whether the person is directlyrecruited for this project). Separate clearly internal staff of your organisation or partners from recruited personnel.

Name FunctionInternal orrecruited

Nr ofdays ormonths

Grosssalary per

day ormonth

Costs

in cash(a)

in kind(b)

Total(a+b)

TOTAL PERSONNEL COSTS

6. Indirect costs [up to 7% of all direct eligible costs (in cash), i.e. budget chapters 1 + 2 + 3 + 4 + 5]

This budget chapter takes account of the general costs incurred in connection with the implementation of the project (e.g., officesupplies, consumables, telecommunication, rent, electric ity, heating, maintenance, depreciation of office equipment)

TOTAL INDIRECT COSTS



20/20

Part VI. BANK DETAILS

Please download and fill in the financial identification form for your country from the following WEB-site:

http://ec.europa.eu/budget/execution/ftiers_en.htm

CECK LIST

Before submitting this application form to the Executive Agency, please check the following:

The proposal submitted in one original only must comprise the following documents:

an official letter of motivation, dated and signed by the person authorised to enter into legally bindingcommitments on behalf of the applicant organisation

the application form, duly completed and signed in original by the person authorised to enter into legallybinding commitments on behalf of the applicant (signatures required in Parts: I.F, II.C and V of the form)

the declaration on honour (Part I.F of the application form), duly completed and signed by the personauthorised to enter into legally binding commitments on behalf of the applicant organisation, attesting to its

status as a legal person and stating that it has the operational and financial capacity to complete theproposed activities, and certifying that none of the situations mentioned in Articles 93(1), 94 and 96(2)(a) ofthe Financial Regulation apply

the mandates (Part II.C of the application form), duly completed and signed by the applicant and thepartners

the estimated budget (Part V of the application form), duly completed (detailed calculation of estimatedcosts included) and signed by the person authorised to enter into legally binding commitments on behalf ofthe applicant organisation

The application must also include the following documents:

the legal entity identification form duly signed by the person authorised to enter into legally bindingcommitments on behalf of the applicant organisation. Please note that complementary justification

documents are required according to the applicants status, as specified in each type of form, i.e.private/public entity. (This form can be downloaded from the European Commissions website:

http://ec.europa.eu/budget/execution/legal_entities_en.htm)

the financial identification form duly signed by the person authorised to enter into legally bindingcommitments on behalf of the applicant and certified by the bank (original signatures required). Please fill inthe form relating to the country in which the bank is located, even in case the applicant organisation isofficially registered in another country. (This form can be downloaded from the European Commissionswebsite:

http://ec.europa.eu/budget/execution/ftiers_en.htm)

the Articles of association (statutes), part I.B of the application form

a copy of the Curriculum Vitae (part I.C of the application form) of the person responsible for the generalcoordination/implementation of the action (contact person)

Additional mandatory documents for grant requests exceeding 25000:

In accordance with the provisions of the Financial Regulation applicable to the general budget of the EuropeanCommunities, all applicant promoters with the exception of public bodies to EU funding exceeding

25000 must submit, together with their application form, the following financial documents:

the balance sheet for the last financial year for which the accounts have been closed

and

the profit and loss accounts of the applicant organisation

the financial capacity form concerning the last financial year for which the accounts have been closed inaccordance with the form available at the website of EACEA:

http://eacea.ec.europa.eu/youth/funding/2009/call_action_4_4_en.php
http://ec.europa.eu/budget/execution/ftiers_en.htmhttp://ec.europa.eu/budget/execution/legal_entities_en.htmhttp://ec.europa.eu/budget/execution/ftiers_en.htmhttp://eacea.ec.europa.eu/youth/funding/2009/call_action_4_4_en.phphttp://ec.europa.eu/budget/execution/ftiers_en.htmhttp://ec.europa.eu/budget/execution/legal_entities_en.htmhttp://ec.europa.eu/budget/execution/ftiers_en.htmhttp://eacea.ec.europa.eu/youth/funding/2009/call_action_4_4_en.php

Documents

To Be Filled in by the Executive Agency