Sample Form for submission of draft Source: CajaSol Foundation, 2008 Sociocultural Project http://sociocultural.mforos.com http://www.monitorsociocultural.com Applicant Entity Project Submission Form Project Title Social Action Program Call 08 Newsletter 1. This document, which is the main instrument for project appraisal should be c ompleted in a concrete, concise and tailored to what is claimed. The space is fo r guidance regarding the extent of the information requested. 2. To help this pr emise have any doubt, has prepared a guide that guides about the contents that a re required to include in the various points of the form. 3. The contents must c onform to the rules of the call and be a true reflection of the reality of the e ntity. 4. Arial 10 is the font type and size to use to complete this document. Social Action Programme Call LEGAL REPRESENTATIVE Mr. / Ms. Entity ID Title Addr ess states that, in view of the Call 2008 Social Action Programme for initiative s and social projects of the Foundation Cajasol, the presentation of the form to the program has been approved by the highest representative bodies of instituti onal and management the entity. Thus, the entity meets the conditions required t o be covered by this announcement and accepts all terms of the same bases. Ask t o be granted the provision of project managed by this entity, to perform in tota l amounting to 08 € to € a budget. Applicant Entity Data Attached are the documents required by the requirements of this notice in the ve racity of which I certify. In on of of I. General Aspects of the Entity Applicant Signature of legal representative and seal of the Institution 1. Legal form Cooperatives Association of Social Initiative Foundation Other (specify) Personal data is transferred to the Foundation Cajasol under this announcement a nd the consent of affected persons for treatment or disposal, shall have been ob tained in accordance with the provisions of Law 15/1999 of 13 December, Protecti on of Personal Data, assuming the participating entities with their legal obliga tions in this regard. Project Submission Form page 2 Call Social Action Program 2. Brief Description of the Entity Intervention Goals Geographic Location Type II. Entity Applicant Resources 08 1. Financial Resources (financial) Entity Type or Subject Private Public Instrument 2. Material Resources Activities according to statutes Ownership Scheme Resources Other Property Rental Sale 3. Members of the governing bodies of the Entity Name Position Principal Function 3. Human Resources 3.1 N º Workers Personal Journey Partial Complete Partial Complete Partial Complete Type Voluntary Temporary Fix Main Task No. Hours Project Submission Form page 3 Call Social Action Program 3.2 Do you have an active volunteer program? No Yes (shares) III. Experience of Applicant Entity 08 1. Experience in social projects (point to least three) Project Title Date Number execution target group beneficiaries Total budget 4. Associative 4.1 Do you work in network through provincial institutions, regional, national and / or international? No Yes (please specify types and reasons) 2. 4.2 Is it an entity declared of Public Utility? Yes No Experience in the type of action requested or to deal with the collective Implementation Date Number beneficiary target group Total budget Project Title 5. Action taken by the Bank for better management and transparency of the same Yes Action Date: Date: Date: No 4 Programme planning Development of strategic plans external audits in the last th ree years Project Submission Form page Call Social Action Program IV. Value of the applicant with the Foundation or Cajasol Cajasol Projects funded in previous calls by the Foundation Cajasol (formerly Fundación El Monte) Project Title Start Date End Date I. Area where you want to execute the Project 08 1. 1. The geographical, social, cultural, economic and political 2. Cajasol Is client? Yes No 2. Projects Project Title made by Company or by others with similar or complementary content to that prese nted (check at least three) Executing agency execution date Headline Impact II. Project Development 1. Type (see coding projects in the Guide) Area of Operation Type Geographic Location Project Data page 5 Project Submission Form Call Social Action Program 2. Diagnosis and justification 4. Institutions involved 08 3. Nature and Description Objectives 5. Staff assigned Name Type Activity in the project cost-time Hours Activities 6. Beneficiary group Men Expected Results No. No. Direct Beneficiaries Indirect Beneficiaries 6 Women Total Project Submission Form page Call Social Action Program 7. Lead time Planned Start Date End date scheduled 10. 08 Innovative aspects and multiplier effects Innovative aspects 8. Monitoring and Evaluation Process Assessment Verification Indicators Sources Multiplier effects Monitoring 11. 9. Dissemination activities planned Viability and sustainability Project Submission Form page 7 Call Social Action Program 08 III. Schedule and Methodology Download file format on the website. IV. Budget Download file format on the website. Project Submission Form page 8