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: |
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TOTAL in EURO: |
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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 |
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Slovak Embassy recommendation:
___________________________
Head of Mission