European Commission

European Initiative for Democracy and Human Rights

CONCEPT NOTE FORM

CAMPAIGN 2: Fostering a culture of human rights
Budget lines 19.04.0 Reference! Europe"id# Deadline for receipt of applications! 1 #11#$00%

&ame of applicant!

Dossier &o
'for official use only(

NOTICE "ll personal data 'such as names) addresses) *+s) etc.( mentioned in your concept note form ,ill -e processed in accordance ,ith Regulation 'E*( &o 4.#$001 of the European /arliament and of the *ouncil of 10 Decem-er $000 on the protection of individuals ,ith regard to the processing of personal data -y the *ommunity institutions and -odies and on the free movement of such data. 1our replies to the 2uestions in this form are necessary in order to assess your grant application and they ,ill -e processed solely for that purpose -y the department responsi-le for the *ommunity grant programme concerned. 3n re2uest) you may -e sent personal data and correct or complete them. 4or any 2uestion relating to these data) please contact the *ommission department to ,hich the form must -e returned. Beneficiaries may lodge a complaint against the processing of their personal data ,ith the European Data /rotection 5upervisor at any time '3fficial 6ournal 7 0) 1$.1.$001(.1 /lease read and complete this form ,ith all due care) in accordance ,ith the guidelines for applicants. /lease note that the procedure has changed. 1ou ,ill only -e re2uested to su-mit a full application form if your concept note is pre8 selected. 1our full application ,ill then undergo evaluation. 9he eligi-ility conformity chec: ,ill only -e performed for the full applications that are provisionally selected according to the score o-tained after the technical evaluation) on the -asis of the supporting documents re2uested -y the European *ommission and the Declaration -y the applicant signed and sent together ,ith the concept note) and the second version sent together ,ith the application form

&ot to -e included in guidelines related to calls for proposals launched in decentralised management

I APP!ICATION "ATA #$EET Note: The %ata on this page &ill 'e enco%e% in the EuropeAi% Co(operation Office)s proposal %ata'ase for use in processing the application an% in esta'lishing an* future contract This %ata must imperati+el* correspon% to that e+entuall* supplie% in the full application form It is the responsi'ilit* of the applicant to ensure that the %ata pro+i%e% on this sheet are correct REF OF THE CALL: 2 TITLE: FOSTERING A CULTURE OF HUMAN RIGHTS BUDGET LINES: 19.04.03 Applicant 4ull &ame "cronym 5heet num-er$ &ationality 7egal 5tatus, *reation date "ddress *ontact person ! 9el ! E8mail ! Title of the Proposal

Geographical region &here the action is to 'e implemente% (tick only one region) #u'( 001 Estern Europe Central -al.ans ME"A Asia #ahara !A Multi( / # Caucasus Asia Africa regional

Main targete% countr*

Total eligi'le cost of the Action Re2ueste% E3 Contri'ution "uration

E;R E;R months

<

= of total eligi-le costs

If the applicant has already signed a contract ,ith the European *ommission E.g. non profit ma:ing) governmental -ody) or other according to the national legislation.

II CONCEPT NOTE FORMAT 9he *oncept &ote must ans,er 4 sets of 2uestions in a ma>imum of 4 pages 'those must -e ans,ered on ma>imum 1 page 8 the font si?e cannot -e smaller than "rial 10(. "ny *oncept &ote not meeting those -asic re2uirements ,ill -e re@ected ,ithout appraisal. Please provide the following information: 4 #ummar* of the action 1.1 Brief description of the proposed action. 2 Rele+ance: 2.1 How relevant is your proposal to the needs and constraints of the target country(ies) or region 2.2 !hat are the pro"lems to "e resolved and the needs to "e met 2.# !ho are the actors involved (final "eneficiaries$ target groups) 2.% !hat are the o"&ectives and e'pected results 2.( !hat is the added value of the action (what adds the action "y reference to (central or local) government action and actions implemented "y non state actors) , Metho%olog* an% #ustaina'ilit*: #.1 !hat are the main pro&ect activities #.2 !ho will "e your main implementing partners$ if any$ what is the length of your relationship with them and how will they "e involved in the pro&ect #.# How will the pro&ect achieve sustaina"ility #.% !ill it have multiplier effects 5 Operational capacit* an% e6pertise: %.1 !hat is the e'perience of your organisation in pro&ect management %.2 !hat is the e'perience of your organisation and your partner(s) of the issues to "e addressed

III.

CHECKLIST
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BEFORE SENDING YOUR CONCEPT NOTE, PLEASE CHECK THAT EACH OF THE FOLLOWING COMPONENTS IS COMPLETE AND RESPECTS THE FOLLOWING CRITERIA :

4. 9he *oncept &ote is drafted follo,ing the pu-lished format for this *all for proposals. 2. " floppy dis: or *d8Rom is enclosed. ,. 9he *oncept &ote is typed and is in English. 5. 9he original is included 7. 9he action ,ill -e implemented in 'an( eligi-le country'ies(. '/lease refer to $.1.1 and $.1. ( 8. 9he duration of the action is e2ual to or lo,er than 1$ months 'the ma>imum allo,ed( 9. 9he duration of the action is e2ual to or higher than 0 months 'the minimum allo,ed( :. 9he re2uested contri-ution is e2ual to or higher than 40 000 E;R3 and than 10 000 E;R3 'the minimum allo,ed(.

4;. 9he re2uested contri-ution is e2ual to or higher than 7;< of the total eligi-le costs 'minimum percentage re2uired(

42. 9he Declaration -y the applicant has -een filled in and has -een signed.

I2. DECLARATION BY THE APPLICANT

A. T*" +,,%$-+') &"-%+/"1 )*+): It has the sources of financing and professional competence and qualifications specified in section 2.3 of the Guidelines for Applicants. It undertakes to comply with the principles of good partnership practice foreseen in section III.2 of the grant application form. It is directly responsible for the preparation and management of the action with its partners, and is not acting as an intermediary. It and its partners do not fall in any of the categories (a to (f list in section 2.!.!(2 of the Guidelines for Applicants. If selected, it is in a position to deli"er in the second phase, immediately upon request, the supporting documents stipulated under point 2.# of the Guidelines for Applicants

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4. P+/)'"/ 7 $1 "%$3$!%" 6$' +-- /&+'-" 4$)* )*" -/$)"/$+ 1") .) .'&"/ , $') 2.1.2 # )*" 3.$&"%$'"1.5 6$# +'(5 NB: add as many rows as partners

B. SIGNATURE: I, the undersigned and person responsible in the applicant organisation for the concept note, certify that the information gi"en in this $eclaration is correct. $ate% &ame% (osition% 'ignature%

4 . %

/lease indicate A&ot "pplica-leB '&"( if you have no partner /lease indicate A&ot "pplica-leB '&"( if you have no partner /lease indicate A&ot "pplica-leB '&"( if you have no partner

= A##E##MENT GRI" >FOR T$E 3#E OF T$E E3ROPEAN COMMI##ION ON!?@

?E# 1. 9he Deadline has -een respected $. 9he *oncept &ote form satisfies all the criteria mentioned in the *hec:list '5ection III of the *oncept &ote form(. 9he verification of the *hec:list has -een conducted -y CCCCCCCCCCCCCCC 3n the CCCCCCCCCCCCCCCCC.. "ECI#ION 4: The Committee has %eci%e% to recommen% the Concept Note for Technical E+aluation after ha+ing passe% the A%ministrati+e chec. 'If not) reasons must -e encoded in the "dministrative chec: Drid in *RI5) in the "dministrative *hec: report in *RI5) and in the letters sent out to applicants(. "ECI#ION 2: After ha+ing pre(selecte% the 'est Concept NotesA the Committee has appro+e% the present Concept Note an% re2ueste% the pre(selecte% applicant to su'mit a full proposal 'If not) reasons must -e encoded in the *oncept &ote Evaluation Drid in *RI5 E this includes the evaluation sheet for assessors and delegations) in the *oncept &ote Evaluation report and in the letters sent out to applicants.(

NO