GRANT AWARD PROCEDURE

APPLICATION FORM

(APPENDIX I)

Call for proposals for Local initiatives on ethical governance and transparency

Strengthening institutional frameworks for local governance

EU/CoE Programmatic Co-operation Framework

2016 CEAD 3263

Text Box: HOW TO COMPLETE THE APPLICATION FORM?

Complete each box with the information requested. The size of the box will adapt to the volume of text typed.

Once all fields are completed, please print, sign and send the Application Form, in accordance with the requirements of the Call for Proposals.

Date of receipt (to be completed by the programme staff)	Please leave box empty.
The number of project (to be completed by the programme staff )	Please leave box empty.

1. Applicant
Official name ►	Click here to enter text.
Legal form ►	Click here to enter text.
Country of registration ►	Click here to enter text.
Full address ►	Click here to enter text.
Internet site (if any) ►	Click here to enter text.
Date on which the applicant was founded ►	Click here to enter text.
Name(s) of the person(s) entitled to enter into legally binding commitments on behalf of the applicant (indicate names and positions) ►	Click here to enter text.

2. Contact details
Contact person ►	Click here to enter text.
Position of the contact person ►	Click here to enter text.
Email address ►	Click here to enter text.
Phone number ►	Click here to enter text.

3. Bank details Bank details provided should be those of the municipality account authorised to receive grant awards. If, due to legal constraints, it is not possible to provide the details of the municipality bank account, please indicate clearly in section 11: the constraints, providing supporting documents where relevant; the owner of the account; the funding structure of the grant proposal.
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.

4. Project overview Please provide a description of the project as follows:
Title ►	Click here to enter text.
Anticipated duration ►	Click here to enter text.
The purpose, goal and specific objective(s)[1] ►	Click here to enter text.
Partner institution/organisation ►	Click here to enter text.
Target groups and beneficiaries[2] ►	Click here to enter text.
Expected results ►	Click here to enter text.

5. Situation analysis (maximum ½ page)

- Provide a synopsis of your Local Government Unit (LGU) in terms of territory, population, development trends, and economy, and the significance of the proposed project/action in this regard.

- Describe the significance of the proposed project at local level and describe the plan to improve the situation. Discuss if the proposed intervention is related to/part of/contributes to any strategy at national and/or regional level related to transparency, accountability and anti-corruption efforts at local government level. ▼

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6. Recent activities and relevant experience in project implementation (maximum ½ page)

Describe below the main projects completed or being carried out in the field concerned during the last 5 (five) years, indicating any grants obtained from other international institutions during the last 5 (five) years (if any). ▼

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Proposed activities (maximum 2 pages)

Under each specific objective listed in section 4, please list the activities to be carried out. For each activity, indicate the title, duration, specific objectives, detailed description, implementation means, evaluation means (if any), and expected results. Activities should be listed in chronological order with approximate dates (if possible). ▼

Before completing this section, please consider the following questions:

- How will the activities undertaken lead to the achievement of the expected results?

- What is the sequence of these activities?

- Who will be responsible for carrying out each activity and what is their role in the project?

- How will the community be involved in the project implementation?

- Who on behalf of the community will be responsible for this role?

- How will gender representation be ensured in the implementation of these activities?

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Potential for awareness raising at national and/or international level (maximum ½ page)

Please describe how the project will contribute to increased visibility and awareness of the role of mayors in promoting ethical standards and behaviour, transparency and accountability to the citizens, and the overall results of the project activities. Will the regional/national government be involved in implementation of the project or in a specific activity ▼

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9. Applicant’s professional and operational capacity (maximum ½ page)

Please indicate below the number of permanent and temporary staff to be involved in the projet/action.

Please describe how will the proposed activities be implemented (where applicable, indicate the involvement of third parties including providers) ▼

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10. Co-funding (maximum ¼ page)

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 contributions or income generated by the action or project ▼

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11. Declaration

By signing this form I, the undersigned, authorised 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 also 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.

12. Signature
Complete the table below and sign in the last box
First Name and Name of the Signatory ►	Click here to enter text.
Title or position of the Signatory in the applicant organisation ►	Click here to enter text.
Place and date of signature ►	Done in: Click here to enter text.
Place and date of signature ►	On: Click here to enter text.

Signature and official stamp of the applicant organisation ►

[1] When formulating the overall goal of the project, please keep in mind that there can only be one and that the implementation of your project will contribute to its achievement. Describe the additional challenges that must overcome in order to achieve the project goal.

[2] Please state how the beneficiaries/the community will contribute to the design, planning and implementation of the project, and how they will be kept informed. Moreover, please indicate what the community role will be in the long-term implementation of the project results.