APPLICATION FORM – STANDARD GRANTS PROGRAMME

       The application was modified for the purpose of the PhD training course PREFEKT 2016.


Project title:


Project category:

Select one category.


Cultural cooperation

                             ☐

Education

                             ☐

Scientific exchange, research

                             ☐


Project outputs:

Pick up to 2 main outputs of the project.


Audio/video production (CD/DVD)

                               ☐

Conference

                               ☐

Exhibition

                               ☐

Festival — Film

                               ☐

Festival — Music

                               ☐

Festival — Theater

                               ☐

Forum (public debates)

                               ☐

Publication

                               ☐

Research

                               ☐

Summer school

                               ☐

Workshop & training

                               ☐

Website

                               ☐

Youth exchange

                               ☐

Other (specify):



 1. Applicant

Name of the organization in its native language:

Name of the organization in English:

Address:
Identification No. of the organization:

URL:

Coordinator of the project:

Coordinator’s e-mail:


Represented by:

2. Project partners

Partner No. 1
Name of the organization in English:

Country:

Website:

Role of the partner:

Partner No. 2
Name of the organization in English:

Country:

Website:

Role of the partner:

Partner No. 3
Name of the organization in English:

Country:

Website:

Role of the partner:

3. Short project description


max. 800 characters

Briefly explain the content of the project







4. Detailed project description


max. 2500 characters

Give a thorough description of the content of the project including its main goals with an emphasis
on the regional dimension.















5. “Visegrad” feature of your project


max. 800 characters

Explain in what way the project is relevant to the V4 region and how it concerns the region or
Central Europe as such. Describe the added value of the regional dimension and justify your funding
request.






6. Target groups benefiting from the project


max. 800 characters





7. Events


Event

     City

         Country

                From (DD/MM/YYYY)

                                 Until (DD/MM/YYYY)

                                                   Number of participants / visitors


























8. Expected outputs


max. 1 000 characters

If the output is a publication, please specify the estimated number of pages and the expected
number of copies to be printed.







9. Planned public relations/promotional activities


max. 1 000 characters

Please indicate the planned dates and events of your promotional activities, as well as the media
you intend to use for promotion.









10. Previous experience in the field


max. 800 characters








11. Continuation of the project:

max. 1 000 characters

Indicate how the project will continue after the conclusion of this grant, if at all.









12. Implementation Period – from DD/MM/YYYY to DD/MM/YYYY

13. Expected results and potential risks

max. 1 000 characters

Please indicate what concretely you expect from the project outcomes. How will you measure the
results of the project? When will you deem it successful and when not? What are the risks?









14. Budget (in €)

Requested contribution and co-financing (in €):



                                     EUR

                                        % of total project costs:

Contribution requested from the fund:



Your own financial contribution:



Total:




Breakdown of the total budget including co-financing (in €):


Printing and publishing costs, delivery


Rent of premises and related technical services


Fees for experts


Accomodation


Transportation costs


Translation, interpreting costs


Office supplies and consumption material


PR costs (e.g. advertising)


Website design and update


Overheads (max. 15% of the Fund's contribution)


Total (must match the approved contribution) :





15. Declarations
On behalf of the applicant I confirm the assumption of obligations connected with the realization
of the project and I declare that all information included in this project proposal are true and
that the relevant institutions which shall co-operate in the framework of the proposed activities,
have approved the project.


Signature of the statutory representative of the Applicant, place and date