APPLICATION FORM PRE-SELECTION OF ORGANISATIONS INTERESTED TO BECOME TACSO SUPPORTED RESOURCE CENTRES

advertisement
Technical Assistance for
Civil Society Organisations
Regional Office
This project is funded
by the European Union.
APPLICATION FORM
PRE-SELECTION OF ORGANISATIONS INTERESTED TO BECOME
TACSO SUPPORTED RESOURCE CENTRES
TACSO Regional Office • Potoklinica 16 • 71 000 Sarajevo • t: +387 33 532 757 • f: +387 33 532 757 • e-mail: [email protected]
SIPU International AB Sweden • Ecorys International Netherlands • Intrac United Kingdom • Foundation Partners for Local Development Romania
• Euclid Network United Kingdom • SMART Croatia
MINIMUM REQUIREMENTS
1. Applicant(s)
Contact Information for Lead Organisation
The applicant's contact details for
the purpose of this action:
Full Name of applicant (in local language and in English)
Abbreviation
EuropeAid ID1
Legal status2
Registration Number
Date of Registration
Place of Registration
Official address of Registration
Country of Registration/ Nationality
E-mail address of the Organisation
Contact person
Contact person's email
Telephone number: Country code +
city code + number
Fax number: Country code + city
code + number
Website of the Organisation
1
To be inserted if the organisation is registered in PADOR. This number is allocated to an organisation which
registers its data in PADOR. For more information and to register, please visit
http://ec.europa.eu/europeaid/onlineservices/pador.
2
E.g. Civil society organizations; Public sector organizations
1
Contact Information for Consortium Partners
Full Name (in local language and in
English)
Legal status
Registration Number
Official address of Registration
Contact information
Full Name (in local language and in
English)
Legal status
Registration Number
Official address of Registration
Contact information
Full Name (in local language and in
English)
Legal status
Registration Number
Official address of Registration
Contact information
Full Name (in local language and in
English)
Legal status
Registration Number
Official address of Registration
Contact information
2
2. Statement of political neutrality
This confirms that the Applicant(s) is not under the influence of a political party. In case
of consortium, the lead organisation confirms that this also applies also to the remaining
consortium members.
Name:
Organisation:
Position:
Signature:
Date and place:
3
3. Information about the Applicant's mission and goals
Please provide your organisation's mission, key objectives and activities (max 1/2 page
for lead organisation, 1/4 page per consortium member).
4
4. Systems for transparency and accountability
4.1 Annual income
Please provide the following information, if applicable, on the basis of the profit and loss
account and balance sheet of your organisation (amounts in thousands Euros):
Turnover or
equivalent
Year
Net earnings
or equivalent
Total
balance
sheet or
budget
Shareholders’
equity or
equivalent
Medium and
long-term
debt
Short-term
debt (<1
year)
2013
2012
4.2 Financing source(s)
Please tick the source(s) of the revenues of your organisation and specify the additional
information requested:
Year
Source
2013
□ EU
2013
□ Member States Public Bodies
2013
□ Third Countries Public Bodies
2013
□ United Nations
2013
□ Other International Organisation(s)
2013
□ Private Sector
2013
□ Member's fees
2013
□ Taxes/Local taxes/Government
donations
2013
Total
Percentage (total for a
given year must be equal
to 100%)
Number of feepaying members
(only for source =
Member's fees)
5
Year
Source
2012
□ EU
2012
□ Member States Public Bodies
2012
□ Third Countries Public Bodies
2012
□ United Nations
2012
□ Other International Organization(s)
2012
□ Private Sector
2012
□ Membership fees
2012
□
Taxes/Local taxes/Government
donations
2012
Total
Percentage (total for a
given year must be equal
to 100%)
Number of feepaying members
(only for source =
Member's fees)
4.3 Annual Financial Reports
The two most recent/available Annual Financial Reports shall be submitted as
attachments to the application form (in English or in national language).
6
4.4 Governance
Please, provide information regarding the lead organisation’s governance, decisionmaking and reporting structures and processes (max 1 page).
7
5. Provision of consultancy and training services to CSOs
5.1. Describe briefly at least three projects, programmes or training interventions for the
civil society conducted during the last two years (max 1/2 page)
5.2. Provide a list of three staff members having three years of experience of civil society
development
Name
Position
8
6. Conformation of availability of office space
Please, confirm the availability of sufficient space to accommodate two national TACSO
project staff members for the period between September 2014 to August 2017 with the
provision of all basic office services (electricity, heating, tel. lines, cleaning, internet
access, etc.).
Yes
No
9
ADDITIONAL SELECTION CRITERIA
1. Applicant's experience of similar actions
1.1 Experience by sector
Please provide a detailed description of actions managed by the organisation/consortium
over the past three years. This information will be used to assess whether the
organisation/ consortium has sufficient and stable experience to assume the role of
TACSO national resource centre.
Sector
Year(s) of
Experience
Experience in the
past 5 years
Number of
Projects in the
past 5 years
Estimated Amount
(in thousand Euros) in
the past 5 years
□ Less than 1
□ Less than 1 year
□ 1 to 5
□ Less than 1
□ 1 to 3 years
□ 1 to 3 years
□ 6 to 10
□ 1 to 5
□ 4 to 5 years
□ 4 to 5 years
□ 11 to 20
□ 5 to 20
□ 5 years +
□ 5 years +
□ 21 to 50
□ 20 to 75
□ 51 to 200
□ 75 to 150
□ 200 to 500
□ 150 to 300
□ 500+
□ 300 to 1.000
help-desk services
□ 1000+
□ Unknown
□ Less than 1
□ Less than 1 year
□ 1 to 5
□ Less than 1
□ 1 to 3 years
□ 1 to 3 years
□ 6 to 10
□ 1 to 5
□ 4 to 5 years
□ 4 to 5 years
□ 11 to 20
□ 5 to 20
□ 5 years +
□ 5 years +
□ 21 to 50
□ 20 to 75
□ 51 to 200
□ 75 to 150
□ 200 to 500
□ 150 to 300
□ 500+
□ 300 to 1.000
Training
□ 1000+
□ Unknown
information events
□ Less than 1
□ Less than 1 year
□ 1 to 5
□ Less than 1
□ 1 to 3 years
□ 1 to 3 years
□ 6 to 10
□ 1 to 5
□ 4 to 5 years
□ 4 to 5 years
□ 11 to 20
□ 5 to 20
□ 5 years +
□ 5 years +
□ 21 to 50
□ 20 to 75
□ 51 to 200
□ 75 to 150
□ 200 to 500
□ 150 to 300
□ 500+
□ 300 to 1.000
□ 1000+
□ Unknown
10
Sector
support for
monitoring and
guidance of
individual projects
Year(s) of
Experience
Experience in the
past 5 years
Number of
Projects in the
past 5 years
Estimated Amount
(in thousand Euros) in
the past 5 years
□ Less than 1
□ Less than 1 year
□ 1 to 5
□ Less than 1
□ 1 to 3 years
□ 1 to 3 years
□ 6 to 10
□ 1 to 5
□ 4 to 5 years
□ 4 to 5 years
□ 11 to 20
□ 5 to 20
□ 5 years +
□ 5 years +
□ 21 to 50
□ 20 to 75
□ 51 to 200
□ 75 to 150
□ 200 to 500
□ 150 to 300
□ 500+
□ 300 to 1.000
□ 1000+
□ Unknown
□ Less than 1
□ Less than 1 year
□ 1 to 5
□ Less than 1
□ 1 to 3 years
□ 1 to 3 years
□ 6 to 10
□ 1 to 5
□ 4 to 5 years
□ 4 to 5 years
□ 11 to 20
□ 5 to 20
□ 5 years +
□ 5 years +
□ 21 to 50
□ 20 to 75
□ 51 to 200
□ 75 to 150
□ 200 to 500
□ 150 to 300
□ 500+
□ 300 to 1.000
advocacy
□ 1000+
□ Unknown
□ Less than 1
□ Less than 1 year
□ 1 to 5
□ Less than 1
□ 1 to 3 years
□ 1 to 3 years
□ 6 to 10
□ 1 to 5
□ 4 to 5 years
□ 4 to 5 years
□ 11 to 20
□ 5 to 20
□ 5 years +
□ 5 years +
□ 21 to 50
□ 20 to 75
□ 51 to 200
□ 75 to 150
□ 200 to 500
□ 150 to 300
□ 500+
□ 300 to 1.000
cross-border
events
□ 1000+
□ Unknown
partner-matching
□ Less than 1
□ Less than 1 year
□ 1 to 5
□ Less than 1
□ 1 to 3 years
□ 1 to 3 years
□ 6 to 10
□ 1 to 5
□ 4 to 5 years
□ 4 to 5 years
□ 11 to 20
□ 5 to 20
□ 5 years +
□ 5 years +
□ 21 to 50
□ 20 to 75
11
Sector
Year(s) of
Experience
Experience in the
past 5 years
Number of
Projects in the
past 5 years
Estimated Amount
(in thousand Euros) in
the past 5 years
□ 51 to 200
□ 75 to 150
□ 200 to 500
□ 150 to 300
□ 500+
□ 300 to 1.000
□ 1000+
civil society PR and
visibility
□ Less than 1
□ Less than 1 year
□ 1 to 5
□ Unknown
□ Less than 1
□ 1 to 3 years
□ 1 to 3 years
□ 6 to 10
□ 1 to 5
□ 4 to 5 years
□ 4 to 5 years
□ 11 to 20
□ 5 to 20
□ 5 years +
□ 5 years +
□ 21 to 50
□ 20 to 75
□ 51 to 200
□ 75 to 150
□ 200 to 500
□ 150 to 300
□ 500+
□ 300 to 1.000
□ 1000+
□ Unknown
1.2 Key Activities
Describe the key activities of the organisation/consortium in TACSO intervention areas
(i.e. help-desk services, training, information events, support for monitoring and
guidance of individual projects, advocacy, cross-border events, partner-matching, as well
as civil society PR and visibility - max 4 pages).
12
2. National coverage
Describe the way that your organisation/consortium covers the territory of the country
with its services (max 1 page).
13
3. Target groups activities
Describe the way your organisation/consortium provides services to specific target
groups (max 1 page).
14
4. English language proficiency
Confirm that the lead organisation has at least two professional staff members having
proficiency in the English language:
Yes
No
15
5. Pool of trainers and experts
Provide CV summaries (max ten sentences) of up to ten trainers/experts engaged in the
organisation’s/consortium’s capacity building activities.
16
6. Research experience
Describe the experience of the organisation/consortium in conducting research, surveys,
etc. (max 1 page).
17
7. Cross-border experience
Describe the regional experience of the organisation/consortium in cross-border events
or partnership projects involving two or more countries (max 1 page).
18
8. Experience of EU projects
Describe the experience of the organisation/consortium in the implementation of EU
funded projects as well as supporting national EU accession processes (max 1 page).
19
PARTNERSHIP STATEMENT
A partnership is a relationship of substance between two or more organisations involving
shared responsibilities in undertaking the action funded by SIPU International/TACSO. To
ensure that the action runs smoothly, the Contracting Authority requires all partners to
acknowledge this by agreeing to the principles of good partnership practice set out below:
1.
All partners must have read the application form and understood what their role
in the action will be before the application is submitted to SIPU International.
2.
All partners must have read the Open Call document. They authorise the lead
applicant to sign the contract with SIPU International and represent them in all
dealings with SIPU International in the context of the action's implementation.
3.
The applicant must consult with its partners regularly and keep them fully
informed of the progress of the action.
4.
All partners must receive copies of the reports - narrative and financial - made to
SIPU International.
5.
Proposals for substantial changes to the action (e.g. activities, partners, etc.)
should be agreed by the partners before being submitted to SIPU International.
I have read and approved the contents of the proposal submitted to SIPU International. I
undertake to comply with the principles of good partnership practice.
Name:
Organisation:
Position:
Signature:
Date and place:
20
Download