Logo JP

Appendix I

APPLICATION FORM

GRANT AWARD PROCEDURE

Human Rights and Democracy in Action

EU/CoE Pilot Projects Scheme

2016 EDC/HRE PPS


  1. APPLICANT

Official name

Click here to enter text.

Legal form

Click here to enter text.

Full address

Click here to enter text.

Website (if any)

Click here to enter text.

Name of the person(s) entitled to enter into legally binding commitments of the applicant (indicate names and positions)

Click here to enter text.
  1. CONTACT DETAILS

Contact persons

Click here to enter text.

Position of the contact person

Click here to enter text.

E-mail address

Click here to enter text.

Phone number

Click here to enter text.
  1. BANK DETAILS

Name of the bank

Click here to enter text.

Address of the bank

Click here to enter text.

Account holder name

Click here to enter text.

Full account number (including bank codes)

Click here to enter text.

IBAN (or BIC Code)

Click here to enter text.


  1. PROPOSED ACTION

  1. Project overview: Please provide a description of the project as follows:

Title:

Click here to enter text.

Objective(s):

Click here to enter text.

Activities:

Click here to enter text.

Partner countries (NB: from 3 to 8, with at least one of the countries being a member of the EU):

Click here to enter text.

Participating organisations/institutions in each country and their roles (ex. coordinator, participant, implementing agency):

Click here to enter text.

Expected results:

Click here to enter text.


  1. Appropriateness and relevance of the action in accordance with the Charter

Please explain how the project will contribute to the aims and objectives agreed by the Council of Europe member states in the Charter on citizenship and human rights education (in the primary, secondary (lower and higher) and initial vocational education and training levels), in accordance with the Terms of Reference for the present pilot project scheme. Please note in particular that the grants will fund projects designed to contribute to the sustainable development and promotion of education for democratic citizenship and human rights education. The present programme cycle will focus on consolidating the outcomes produced so far (see outcomes 2013 - 2014) and support will be provided to the translation, adaptation, further development and dissemination of the previous outcomes, further piloting of the existing tools and supporting their introduction in the education systems of the participating countries. 

Click here to enter text.

  1. Potential impact on educational policy and practice in the participation countries

Please describe how the project will impact the educational policies and practices in the participating countries, including possible ways of evaluating such impact (1-2 years after the project)

Click here to enter text.

  1. Potential for awareness raising at national and/or international level

Please describe how the project will contribute to increased visibility and awareness of the role of citizenship and human rights education for the future of democratic societies and specify what visibility material is expected to be produced (ex. video and/or audio products, coverage on relevant websites, the use of social media, coverage in specialised magazines, other publications)

Click here to enter text.

  1. Participation of NGOs, youth organisations/associations, parents associations in the project design and implementation

Please describe how non-governmental organisations (national or international), youth organisations/associations and parents associations will contribute to the project design and implementation.  In particular, you might wish to provide an indicative list of organisations, number of organisations, methodology for cooperation, your previous experience with respect to cooperation and potential for sustainability for such cooperation.

Click here to enter text.

F.       Participation of the States party to the European Cultural Convention, which had not previously taken part in the pilot projects

Please indicate whether one or more of the following countries are among the partners for the present project proposal:

1. Andorra 2. Armenia 3. Azerbaijan 4. Belgium 5. Bosnia and Herzegovina 6. Bulgaria 7. Czech Republic 8. Denmark

9. Estonia 10. Germany 11. Holy See 12. Iceland 13. Italy 14. Kazakhstan 15. Latvia 16. Liechtenstein 17. Luxembourg

18. Malta 19. Monaco 20. Netherlands 21. Norway 22. Portugal 23. Republic of Moldova 24. San Marino 25. Serbia

26. Slovak Republic 27. Slovenia 28. Switzerland 29. “the former Yugoslav Republic of Macedonia” 30. Turkey

31. Ukraine.

Click here to enter text.


  1. Action plan

Briefly present your plan for the implementation of activities until 30 March 2017

Activity

Jun 2016

Jul

2016

Aug

2016

Sept

2016

Oct

2016

Nov

2016

Dec

2016

Jan

2017

Feb

2017

March

2017

  1. APPLICANT’S OPERATIONAL CAPACITY

Indicate below how the applicant intends to implement the proposed action (where applicable, indicate the involvement of third parties including providers)

Click here to enter text.

  1. CO-FUNDING

Please explain your available resources and needed resources to implement the project. Indicate below how the applicant intends to contribute to the project (either by way of its own resources or by contribution from third parties). Co-financing may take the form of financial or human resources, in-kind contribution or income generated by the action.

Remark concerning the budget table (appendix II):  The budget will not cover operating costs of national administration personnel assigned to the project, but only direct, eligible costs such as travel, hotel, special costs associated to meetings (venue, interpretation, stationery, secretariat, etc.). Exception may be made for contracting national experts (working language English or French) to help planning and coordinating project activities and inasmuch as non-governmental entities (national or international) are called in to participate in the pilot project, for expertise and research, with standard fees being accepted as part of the budget. Please submit one budget table per partner country.

Click here to enter text.

7.    
DECLARATION

I, the undersigned, authorized to represent the applicant, hereby certify that the information contained in this application is correct and that the applicant organisation has not received or applied for any other Council of Europe funding to carry out the action which is the subject of this grant application.

I certify on my honour that the applicant organisation is not in one of the situations which would exclude it from taking part in a Council of Europe grant award procedure, and accordingly declare that the applicant:

a. has not been sentenced by final judgment on one or more of the following charges: participation in a criminal organisation, corruption, fraud, money laundering;

b. is not in a situation of bankruptcy, liquidation, termination of activity, insolvency or arrangement with creditors or any like situation arising from a procedure of the same kind, or is not subject to a procedure of the same kind;

c. has not received a judgment with res judicata force, finding an offence that affects its professional integrity or constitutes a serious professional misconduct;

d. does comply with its obligations as regards payment of social security contributions, taxes and dues, according to the statutory provisions of the country where it is established.

  1. SIGNATURE

Name / First name of the Signatory

Click here to enter text.

Title of position in the applicant’s organisation

Click here to enter text.

Place of signature

Click here to enter text.

Date of signature

Click here to enter text.

Signature and official stamp of the applicant