Annex 2
EEA Grants 2009-2014: NGO Programme Lithuania. Guidelines for Applicants
PROJECT CONCEPT APPLICATION FORM
EUROPEAN ECONOMIC AREA FINANCIAL MECHANISM
NGO PROGRAMME LITHUANIA
____________________________________________________________________________________
(Name of applicant)
______________________________________
(date)
Project registration No. ________________________
(filled in by Programme Operator staff)
Description of the project concept shall not exceed 5 pages prepared in font 11, Times New Roman or Calibri, single
spacing. Completed form should be forwarded to:
The form must be filled out in Lithuanian with the summary in English
TITLE OF THE PROJECT
AREA OF THE PROJECT
Choose from the list provided in the Guidelines for Applicants (section Objectives, Areas of Support and Expected
Results).
Comment: the choice is not limited, but please make a realistic assessment bearing in mind the Project‘s scope and
capacity of the implementing team.
INFORMATION ABOUT THE APPLICANT
Information about the Organisation:
1. Full name of Organisation and its acronym
2. Registration code
3. Legal status
4. Stakeholders
5. Address of registration
6. Address for correspondence (if different from the address of registration)
7. Phone number
8. E-mail, website
9. Head of Organisation
10. Project contact person, phone, e-mail
Provide a short description of objectives and activity of the Organisation, its experience in the outcome area of the
project, administrative and project implementation capacities of the applicant that will be available for the Project.
INFORMATION ABOUT PARTNER/S (IF IDENTIFIED ALREADY)
Information about the Organisation:
1. Name of Organisation
2. Registration code
3. Legal status
4. Stakeholders
5. Address of registration
6. Phone number
7. E-mail, website
8. Head of Organisation
Provide a short description of objectives and activity of the Organisation, its experience in the outcome area of the
project, administrative and project implementation capacities that will be available for the Project.
INFORMATION ABOUT ASSOCIATE PARTNER/S (IF IDENTIFIED ALREADY)
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Annex 2
EEA Grants 2009-2014: NGO Programme Lithuania. Guidelines for Applicants
Information about the Organisation:
1. Name of Organisation
2. Registration code
3. Legal status
4. Address of registration
5. Phone number
6. E-mail, website
7. Head of Organisation
Provide a short description of objectives and activity of the Organisation. Indicate the Organisation‘s role in the
Project.
Comment: Associate partner is a partner of the Project who does not benefit and is not recipient of the Project, but
assists the applicant to implement the activities and contributes to achieving the Project‘s objectives.
PROJECT CONCEPT/IDEA
Describe the concept of the Project:
- Clearly describe and provide justification of the problem issue which is addressed by the project, describe its
relevance to the area of support, the outcomes and the outputs.
- Indicate the Project‘s objective, tasks, activities and targets to be achieved and explain how the Project‘s results
will match the Programme‘s outcomes and outputs.
- Describe the impact of the Project on the strengthening and capacity development of your organisation and (if
this is foreseen) the whole NGO sector.
- Describe the Project‘s target groups and beneficiaries.
- If the Project will be implemented with partner/s, describe the distribution of roles among partners, explain the
value of partnership for the Project and indicate concrete activities of partner engagement and responsibilities
of partners.
Comment: Activities of the Project must match the eligible activities listed in the Guidelines for Applicants (section
Eligible Activities).
PROJECT‘S IMPACT ON HORIZONTAL CONCERNS OF NGO PROGRAMME LITHUANIA
Indicate Project‘s connections with the horizontal concerns of NGO Programme Lithuania listed below. Indicate
concrete actions which will be taken to achieve maximum impact. Horizontal concerns include:
Combat:
- Hate speech, hate crime and extremism,
- Racism and xenophobia,
- Homophobia,
- Anti-Semitism,
- Roma discrimination,
- Sexual harassment,
- Violence against women and domestic violence,
- Human trafficking.
Foster:
- Tolerance,
- Multicultural understanding.
PROJECT BUDGET
Provide a summary of project implementation budget according to the stages of project implementation.
Project budget shall be planned realistically, grounding them on average market prices and clearly linking to the
implementation of planned activities or group of activities. The budget shall be adequate to the achievement of the
planned results.
Clearly identify where the budget is used for outsourcing/sub-contracting. No more that 40 percent of activities can be
outsourced to other organisations/individuals (in exceptional circumstances if properly justified, a higher amount of
subcontracting may be allowed). Indirect costs are set as a flat rate of up to 20% of total direct eligible costs, excluding
direct eligible costs for subcontracting and the costs of resources made available by third parties which are not used
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Annex 2
EEA Grants 2009-2014: NGO Programme Lithuania. Guidelines for Applicants
on the premises of the project promoter. The total amount of indirect costs cannot exceed 50 thousand LTL. Identify
clearly the contribution of the applicant to the budget (Note that the applicant should contribute at least 10 percent
of the budget from own resources).
Provide a summary of the Project Budget, showing funding needs according to categories of expenditures:
Categories of expenditures
Amount, LTL
Amount, EUR
Direct expenditures of Project implementation
Stage 1
Stage 2
Stage n
Direct expenditures of administration
Indirect costs
PROJECT BUDGET, IN TOTAL
Funding of NGO Programme Lithuania
Contribution by the applicant
OTHER INFORMATION RELATED TO THE PROJECT (if the Applicant would like to add it)
Project Concept Summary in Lithuanian and English
Please provide information in English:
Name of the applicant
Name of the partner/s
Title of initiative
Provide a summary of the Project in Lithuanian and English, indicating the problem addressed by the Project, its
outcome and outputs, objective and tasks of the Project; main activities, indicators of results and stages of Project
implementation, duration of the Project, total budget (in LTL) and Organisation‘s contribution (in LTL).
DOCUMENTS TO BE SUBMITTED WITH THE PROJECT CONCEPT APPLICATION FORM
1. Copy of Statute of the organisation (if the statute was modified during the 2011-2013 period, the earlier
version must be provided as well);
2. Copy of registration certificate;
3. Letter of authorisation (if the application is signed not by the head of the organisation);
4. Applicant declaration (Annex 4);
5. Partner / Associate partner declaration (if applicable) (Annex 5; Annex 6);
6. Partnership agreement (if applicable) or letter of intent regarding the cooperation within the project ;
7. CVs or short description of relevant experience in project area of project implementation team;
8. List of completed projects in the area where funding is requested (indicating project name, dates of
implementation, source and amount of funding, project objective, main activities and results) (Annex 7);
9. Annual report on received and used support in 2011-2012 (Form FR 0478).
________________________________________________________________________
Job title and name, surname, signature of the Head of Organisation or authorised person, date
<stamp>
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