Technical Assistance for Civil Society Organisations Regional Office This project is funded by the European Union. Application Form Support to Regional CSO Networks Details of Network ! If your organisation has registered for our Regional Conference for Regional CSO Networks in IPA countries, Sarajevo December 2011, then please just provide information for fields marked with * Regional Network and designated person Name of the regional network* Base Country Address, phone, fax, e-mail, etc. Name and details of contact person (e-mail, phone etc.)* Legal status of the regional network If formally registered, date of registration of network Sector/theme of work Geographic area of work Total number of member organisations Proposal οThe proposal should be 2-3 pages long maximum. Title of the Activity Proposed (main type of activity for which the application is for –advocacy/policy work/study visit, etc) Background information (problem statement, action justification, connection with specific policy) Lot (please identify lot number) TACSO Regional Office • Potoklinica 16 • 71 000 Sarajevo • t: +387 33 532 757 • f: +387 33 532 757 • e-mail: info@tacso.org SIPU International AB Sweden • Civil Society Promotion Centre Bosnia and Herzegovina • Human Resources Development Foundation Turkey Foundation in Support of Local Democracy Poland • Partners Foundation for Local Development Romania 1 Technical Assistance for Civil Society Organisations Regional Office This project is funded by the European Union. Objectives (overall objective, purpose and expected results) Sustainability of the outcomes and outputs deriving from the supported action Market distortion plan (type of pro bono services your network is planning to deliver in return to smaller/rural CSO, when and how) Action location and duration Total budget breakdown Amount requested from TACSO, with detailed costs specifications TACSO Regional Office • Potoklinica 16 • 71 000 Sarajevo • t: +387 33 532 757 • f: +387 33 532 757 • e-mail: info@tacso.org SIPU International AB Sweden • Civil Society Promotion Centre Bosnia and Herzegovina • Human Resources Development Foundation Turkey Foundation in Support of Local Democracy Poland • Partners Foundation for Local Development Romania 2