SMALL GRANT APPLICATION FORM

                                                                                                                Príloha č. 1  k Smernici č.92/2009  

SMALL GRANT APPLICATION FORM   

The Application Must Be Submitted in English

Name of the project:

Name of the organization (English translation):

Name of the organization (in local language):

Address:

Phone and fax numbers, e-mail address:

Represented by (name, title):

Background of the representative (please state the representative´s title and background and attach CV of the people who will be engaged in the project):

Background of the organization (please attach a copy of the registration papers):

Any previous Slovak Government funding:

Project start date: (month/year)

Project end date: (month/year)

(Note: Max. project contractual period not to be exceed 6 months)

Amount requested (in EURO):

Project description:

Project purpose(what goals will be achieved and how the results will be determined/measured):

Project justification (please describe the need or problems the project will solve and the target groups):

Project sustainability:

Detailed description of the project activities:

Detailed budget (please use the table below):

Budget items:	Price per unit:	Number of units:	Slovak Embassy budget:	Final Beneficiary cost sharing if applicable:	Other support cost sharing if applicable:	Total in EURO:
TOTAL in EURO:

How will you meet the program and financial reporting requirements (e.g., who will prepare the financial report?):

Final Beneficiary cost sharing if applicable, (other support cost sharing if applicable):

Other organizations you applied to with the same project and status of your application:

_________________________                                                         __________________________

City, date                                                                                                         Signature of Applicant

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SLOVAK EMBASSY RECORDS ONLY

Application No.	Received (date)	Amount Requested	Amount Awarded

Slovak Embassy recommendation:

                                                                                                                                ___________________________

                                                                                                                                                Head of Mission