Sie sind auf Seite 1von 10

Programme funded by the EUROPEAN UNION CONTRACTING AUTHORITY Romanian Ministry of Regional Development and Tourism Joint Operational

Programme Romania-Ukraine-Republic of Moldova 2007-2013 GRANT APPLICATION FORM Reference: 2nd call for proposals, Restricted call for proposals Deadline for submission of Concept Notes 30th of January 2012 (first step) For economical and ecological reasons, we strongly recommend that you submit your files on paperbased materials (no plastic folder or divider). We also suggest you use double-sided print-outs as much as possible. Title of the action: Number and title of the priority Number and title of the measure SHKDFBEILUYTUM0T9UIBM0TKYUHPD0SUMV089 Priority 3 People-to People cooperation

3.2 Educational, social and cultural exchanges

ROMANIA Country , SUVEAVA county, SUCEAVA town REPUBLIK OF MOLDOVA Country, Chisinau district, Chisinau town REPUBLIK OF MOLDOVA Country, BALTI district, BALTI town Location(s) of the action: UKRAINE Country, Chernivetska o b la st , CE RNA UT I t o wn [specify country(ies), county(ies)/oblast, district(s), town(s)/locality(ies) that will benefit from the Action] Name of the applicant [in English and in the national language] UNIVERSITATEA STEFAN CEL MARE, SUCEAVA Nationality of the applicant1 ROMANIAN NATIONALITY

Dossier No (for official use only)

The statutes must make it possible to ascertain that the organisation was set up by an act governed by the national law of the country concerned. In this respect, any legal entity whose statutes have been established in another country cannot be considered an eligible local organisation. The international organisations does not have to fulfil the nationality requirements (see also sections 2.1.2.1. and 2.1.2.2 of the Guidelines for applicants) Page 1 of 10

2010 Grant Application Form for Priority 3 People to people cooperation

Page 2 of 10

Ongoing contract / Legal Entity file number (if available)2 Legal status3 Partners4 Partner 1 Partner 2 Partner 3

Not applicable

University [Name in English and in the national language, Legal status, Nationality]`` The Alecu Russo Balti State University Uiversitatea de stat Alecu Russo din Balti The Moldova State University Universitatea de stat din Moldova, Chisinau ,,,,,,,,,,,,,,,,,,,,, Universitatea cernauti

CONTACT DETAILS OF THE APPLICANT FOR THE PURPOSE OF THIS ACTION: Postal address: Str. Universitatii 13, 720229 Suceava, Romania

Telephone number: (fix and mobile) [Country code + city code + number] Fax number: [Country code + city code + number] Contact person for this action: Contact persons email address: Website of the organization

Tel: +40 230 216 147

Fax: +40 0230 520 080

Professor doctor Costin Claudia Email: rectorat@usv.ro www.usv.ro

Any changes in the addresses, phone numbers, fax numbers and in particular e-mail, must be notified in writing to the Joint Technical Secretariat. The Contracting Authority or the Joint Technical Secretariat will not be held responsible in case it cannot contact the applicant.

2 3 4

If an applicant has already signed a contract with the European Commission and/or has been informed of the Legal Entity file number; if neither of this apply, indicate N/A Check carefully Section 2.1.1 Eligibility of applicants: who may apply? of the Guidelines for grant applicants. E.g. non profit making, governmental body, public institution, public administration, public bodies, international organisation Add as many rows as partners Page 2 of 10

2010 Grant Application Form for Priority 3 People to people cooperation

Page 3 of 10

TABLE OF CONTENTS

UKRAINE COUNTRY, CHERNIVETSKA OBLAST,CERNAUTI TOWN..........................................................1

PART A. CONCEPT NOTE...........................................................................................4


1. INSTRUCTIONS FOR DRAFTING OF THE CONCEPT NOTE................................................4
1.1 SUMMARY OF THE ACTION (MAX. 1 PAGE)...............................................................................................4

UKRAINE COUNTRY, CHERNIVETSKA OBLAST,CERNAUTI TOWN..........................................................4


1.2 RELEVANCE AND THE CROSS BORDER IMPACT OF THE ACTION (MAX. 5 PAGES).........................5 1.3 DESCRIPTION OF THE ACTION (MAX. 4 PAGE) .........................................................................................6

2. CHECKLIST FOR CONCEPT NOTE.............................................................................................7 3. DECLARATION BY THE APPLICANT FOR CONCEPT NOTE..............................................8 4. PARTNERSHIP STATEMENT .......................................................................................................9 5. ASSESSMENT GRID FOR THE CONCEPT NOTE...............................................................................................10

Page 3 of 10

PART A. CO NCE P T NO TE 1. I NS TRUCTI O NS FO R DR AFT I NG O F THE CO NCE P T NO TE There is no specific template for the Concept Note but the applicant has to ensure that the text of its concept note:

Does not exceed 10 full pages (A4 size) of Arial 10 characters with 2 cm margins;

Responds, in the same sequence, to the headings listed below. It is expected that the size of each section will reflect the relative importance of each heading (ref max scores in the Evaluation Grid and in the Guidelines). The evaluation will be carried out in accordance with the evaluation grid and it will be based solely on the information provided by the applicant in the concept note. Is drafted as clearly as possible to facilitate its assessment.

Please note that, when assessing the Concept Note, the Evaluation Committee will only consider the first 10 pages. Moreover, all the information requested by the published instructions for drafting of the Concept Note must be provided. Consequently, the non-observance of the maximum number of pages requirement may conduct to the rejection of the application.

1.1

SUMMARY OF THE ACTION (max. 1 page)

Please complete the table below, which should not exceed 1 page. Title of the action Aim of the priority addressed by the action Location(s) of the action To promote greater interaction between people and communities living in the border areas [country(ies), county(ies)/oblast(s), district(s)/locality(ies) that will benefit from the action] ROMANIA Country , SUVEAVA county, SUCEAVA town REPUBLIK OF MOLDOVA Country, Chisinau district, Chisinau town REPUBLIK OF MOLDOVA Country, BALTI district, BALTI town UKRAINE Country, Chernivetska ob la st , CE RNA UT I t o wn Total duration of the action Amount of requested EU contribution Objectives of the action 14 months [..] EUR Overall objective(): The general objective of the programme is to improve the economic, social and environmental situation in the Programme area, in the context of safe and secure borders, through increased contacts of partners on both sides of the border.

Page 4 of 10

Specific objective(s): Pregiunile implicate integrarea lor in prin crearea unui Centru Transfrontalier comun

1. Constientizarea si promovarea valorilor multiculturalitatii din regiunile proiectului prin cunoasterea valorilor etnografice specifice romanilor, moldovenilor si ucrainenilor Target group(s)5 Final beneficiaries6 Estimated results7 Mactivities

1.2 1.2.1

RELEVANCE AND THE CROSS BORDER IMPACT OF THE ACTION (max. 5 pages) Relevance to the objectives/sectors/themes/priority of the call for proposals

Please provide all the following information: a) Describe the relevance of the action to the objective(s) and priority (ies) of the Call for proposals. b) Describe the relevance of the action to the specific themes/sectors/areas and any other specific requirements indicated in the guidelines of the call, such as cross border partnership, local ownership, cross border impact etc. c) Describe which particular expected results mentioned in the guidelines of the call (Annex L Priority indicators) will be addressed. d) Indicate how the project pursues to create basis for effective cross border cooperation by putting into practice at least two of the following cross border cooperation criteria: joint project development, joint project implementation, joint staffing, and joint financing. e) Please explain what are the benefits foreseen at the level of the cross border area, what changes they will support and how they will contribute to the projects specific objective(s). In exceptional cases when an organisation located outside the Programme area is involved as a partner in the project , please justify the necessity of including it in the project 1.2.2 Relevance to the particular needs and constraints of the target country/countries, region(s) and/or relevant sectors (including synergy with other EU initiatives and avoidance of duplication) Please provide all the following information: a) Identify clearly the specific pre-project situation in the target country/countries, region(s) and/or sectors (include quantified data analysis where possible and make reference to official data). b) Provide a detailed analysis of the problems to be addressed by the action and how they are interrelated at all levels. c) Where the action is a continuation of a previous action clearly indicate how the proposed action is intended to build on the activities/results of this previous action; refer to main conclusions and recommendations of evaluations that might have been carried out.
5 6 7

Target groups are the groups/entities who will be directly positively affected by the project at the Project Purpose level. Final beneficiaries are those who will benefit from the project in the long term at the level of the society or sector at large. Results are the tangible products/ services delivered as a consequence of implementing a project.

Page 5 of 10

d) Where the action is part of a larger programme, clearly explain how it fits or is coordinated with
this programme or any other planned project. Specify the potential synergies with other initiatives, in particular from the European Commission. I e) In addressing the points above, refer to any significant strategies and action plans undertaken at national, regional and/or local level relevant for the action and describe how the action will relate to such plans. Provide reliable sources of information and if available, provide web links where the documents may be consulted. Where the project innovates and is not framed in a national/regional strategy or action plan, indicate the added value of the project from the perspective of programme objectives and complementarity with the national and regional strategies. 1.2.3 Describe and define the target groups and final beneficiaries, their needs and constraints and how the action will address these needs Please provide all the following information, indicating reliable sources: a) Include a description of each target groups and final beneficiaries (quantify where possible), including criteria for their selection. b) Identify needs and constraints of each target groups and final beneficiaries. c) Demonstrate the relevance of the proposal to the needs and constraints of the target groups and final beneficiaries. d) Explain any participatory process ensuring participation of the target groups and final beneficiaries. 1.2.4 Particular added-value elements

Indicate how the proposal contribute to promotion or consolidation of public/private partnerships, innovation and best practices, or other cross-cutting issues such as environmental issues, promotion of gender equality and equal opportunities, needs of disabled people, rights of minorities and rights of indigenous people.

1.3 DESCRIPTION OF THE ACTION (max. 4 page) Please provide all the following information: a) Background to the preparation of the action. b) Describe the objectives of the action. (Elaborate here on the objectives mentioned in the table in section 1.1 above.) c) Describe the key stakeholders groups, their attitudes towards the action and any consultation undertaken with them. d) Provide brief information on the type of activities foreseen and specify related outputs and results, including a description of linkages/relationships between activity clusters. e) Indicate a broad timeframe for the action and describe any specific factor that has been taken into account. f) In exceptional cases, when projects can take place partially in regions other than those defined by the programme area, please explain why is this necessary for achieving projects objectives

Page 6 of 10

2. CHE CKLI S T FO R CO NCEP T NO TE Joint Operational Programme Romania-Ukraine-Republic of Moldova 2007-2013 Priority 3 People to people cooperation 2nd Call for proposals ADMINISTRATIVE DATA Name of the applicant Country and date of registration Legal Entity File number 8 Legal status 9 Partner 1 Partner 2 [Add as many rows as partners] Name [in English and in the national language]: Country of registration: Legal status: Name [in English and in the national language]: Country of registration: Legal status: [To be filled in by the applicant] [in English and in the national language]

Before sending your Concept Note, please check that each of the following points is complete and respects the following criteria Title of the Proposal: PART 1 (ADMINISTRATIVE) 1. The instructions for concept note, published for this call for proposals, have
8 9

To be filled in by the applicant YES NO

If the applicant has already signed a contract with the European Commission E.g. non profit making, governmental body, international organization, public body, etc.

Page 7 of 10

been followed: max. 10 full pages, (A4 size) of Arial 10 characters with 2 cm margins? 2. The Declaration by the applicant has been filled in, signed, stamped, dated and is enclosed? 3. The partnership statement(s) signed stamped and dated by each partner is /are enclosed? 4. The proposal is typed and is in English? 5. One original and 4 copies are included? 6. An electronic version of the concept note (CD-ROM) is enclosed? 7. An electronic copy of the national/strategies, action plans, relevant for the project is enclosed, or a web link was provided? PART 2 (ELIGIBILITY) 8. The applicant and partner(s) organisations are located in the programme area, or participation of a partner located outside the programme area is motivated in the concept note? 9. The entire action will be implemented in the eligible area of the programme, or When part of the action will take place in regions other than those defined by the programme area, a duly justifications was provided by the applicant in the concept note ? 10. The duration of the action is between 6 months (the minimum allowed by this Call) and 18 months (the maximum allowed by this Call)? 11. The requested EU contribution is between 30,000 EUR (the minimum allowed by this Call) and 150,000 EUR (the maximum) allowed by this Call)? 12. The present Checklist and the Declaration by the applicant are filled in and sent with the Concept Note? 3. DE CLAR AT I O N BY THE AP P LI C AN T FO R CO NCE P T NO TE The applicant, represented by the undersigned, being authorised signatory for the applicant, and in the context of the present application, representing any partners in the proposed action, hereby declares that a) The applicant has the sources of financing and professional competence and qualifications specified in section 2 of the Guidelines for Applicants;

b) The applicant undertakes to comply with the obligations foreseen in the partnership statement of the grant application form and with the principles of good partnership practice;

c) The applicant is directly responsible for the preparation, management and implementation of the action with its partners, and is not acting as an intermediary; d) The applicant and its partners are not in any of the situations excluding them from participating in contracts which are listed in Section 2.3.3 of the Practical Guide to contract procedures for EU external actions (available from the following Internet address) http://ec.europa.eu/europeaid/work/procedures/implementation/index_en.htm Furthermore, it is recognized and accepted that if we participate in spite of being in any of these situations, we may be excluded from other procedures in accordance with section 2.3.5 of the Practical Guide;

Page 8 of 10

e) The applicant and each partner are in a position to deliver immediately, upon request, the supporting documents stipulated under section 2.4 of the Guidelines for Applicants;

f)

The applicant and each partner are eligible in accordance with the criteria set out under sections 2.1.1 and 2.1.2 of the Guidelines for Applicants;

g) If recommended to be awarded a grant, the applicant accepts the contractual conditions as


laid down in the Standard Contract annexed to the Guidelines for applicants (annex IIA);

h) The applicant and its partners are aware that, for the purpose of safeguarding the financial interests of the European Union, their personal data may be transferred to internal audit services, to the European Court of Auditors, to the Financial Irregularities Panel or to the European Anti-Fraud Office. Signed on behalf of the applicant Name Signature and stamp Position Date

S T AT E ME NT 1 0 I hereby certify that the [insert the name of the organization that fills in the partnership statement in English and in national language] commits itself to the operation. I confirm that no expenditure related to the activities foreseen to be implemented in the above mentioned project by [insert the name of the organization that fills in the partnership statement - in English and in national language] has been funded by any other EU programme. I have read and approved the contents of the concept note submitted to the Joint Managing Authority (the Ministry of Regional Development and Tourism from Romania). I undertake to comply with the principles of good partnership practice. Signed on behalf of the Partner [insert the name of the organization that fills in the partnership statement in English and in national language]:

4. P ART NE RS HI P

10

To be multiplied and filled in by each project partner. This parnership statement must only be filled in by project partners.It is not necessary for the Applicant to sign a partnership statement.

Page 9 of 10

Name11: Organisation: Position: Signature and stamp: Date and place:

5. AS S E S S ME NT G RI D FO R THE CO NCE P T NO TE (For the use of the Contracting Authority only)

YES 1. The submission deadline has been respected? 1. The Checklist has been duly completed? The administrative verification has been conducted by: Date: DECISION 1: The Committee has decided to evaluate the Concept Note after having passed the Administrative Check. The evaluation of the Concept Note has been conducted by: Date: DECISION 2: The Committee has decided to recommend evaluating the full application form.

NO

11

Legal representative of the organization


Page 10 of 10