CEI Cooperation Fund

Application Form

for Funding a CEI Cooperation Activity

1. General Information

1.1. Title

Title and acronym, as appropriate, of the Cooperation Activity

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1.2. Applicant

Country, name and brief description of the applicant's organisation

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Legal status of the applicant (public body, private entity, NGO, international organisation or other, and reference to type of documentation attached as registration proof)

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1.3. Intended date and place of implementation

Please refer to the exact date and venue of the proposed activity. In case of longer programmes or actions, please define which is the portion requesting CEI support. Please note that the CEI does not finance multiple events. Generic information will not be accepted.

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1.4. Budget overview

Total budget: 0,00 €

Requested CEI contribution: 0,00 €

1.5. Past experience with CEI

Please state whether you have been applicant, recipient, partner or beneficiary directly or indirectly in any CEI activities/projects of any kind. If so, please provide the relevant details (Reference Number, Title, Amount of CEI contribution received, etc.). Please refer as well to any other activity that has not been eventually approved or classified for co-financing in past Calls.

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2. Description of the activity

2.1. Origin and background (Max 1500 characters)

Please provide a brief description of the motivations that led to the presentation of the current proposal. Should the proposal be a follow-up of any other activity please elaborate on that as well.

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2.2. Description, objectives and expected results (Max 2500 characters)

Please provide brief information on the main features of the proposed activity with particular attention to appropriate, practical and consistent information. Nonspecific and abstract, overambitious goals are to be avoided.

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2.3. Compatibility with CEI Plan of Action (Max 1500 characters)

Please refer to exact Chapter and priority area of the Plan of Action in which you consider your proposal to better fit in. Please explain how the proposed activity is meeting the Plan of Action goals. Please restrict your choice to one priority area. Multiple reference is to be avoided.

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2.4. Relevance to macroregional strategies’ objectives (Max 1500 characters)

Applicants are invited to elaborate on existing or possible relevance of the proposed action to the implementation of macroregional and SEE 2020 strategies and involvement of CEI Member States targeted by the Eastern Partnership.

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2.5. Promotional activities and CEI visibility (Max 1500 characters)

Please describe which actions you are planning to promote the proposed activity and ensure CEI visibility in its framework, as well as the dissemination activities in the post-implementation phase.

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2.6. CEI Involvement (Max 1500 characters)

Indicate which CEI bodies or national CEI representatives (see the CEI website for more information) you intend to involve in the preparation and implementation of the Cooperation Activity, if any. Please motivate the indication given.

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2.7. Participation

Please indicate the envisaged number and role of participants in the Cooperation Activity. Generic and nonspecific reference is to be avoided.

CEI	Envisaged number	Institution	Role in the Cooperation Activity (participant / speaker / organiser)
Albania
Austria
Belarus
Bosnia and Herzegovina
Bulgaria
Croatia
Czech Republic
Hungary
Italy
Macedonia
Moldova
Montenegro
Poland
Romania
Serbia
Slovakia
Slovenia
Ukraine
TOTAL
Other	Envisaged number	Institution	Role in the Cooperation Activity (participant / speaker / organiser)
TOTAL
International bodies	Envisaged number	Institution	Role in the Cooperation Activity (participant / speaker / organiser)
TOTAL

2.8. Registration fee

If a registration fee is applied, please indicate the amount of the fee in Euro, to which categories of participants it is applied, which budget lines are to be covered by the registration fee. Please indicate the revenue from registration fees in the co-financing scheme, as appropriate.

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3. Organisation and administration

3.1. Legal representative of the Applicant Institution

First Name and Family Name: […]

Official position: […]

Institution: […]

Address: […]

Telephone: […]

Fax: […]

Email: […]

Website: […]

3.2. Person responsible for the implementation and final reporting

First Name and Family Name: […]

Official position: […]

Institution: […]

Address: […]

Telephone: […]

Fax: […]

Email: […]

Website: […]

3.3. Person responsible for financial management and final accounting

First Name and Family Name: […]

Official position: […]

Institution: […]

Address: […]

Telephone: […]

Fax: […]

Email: […]

Website: […]

4. Budget

4.1. Detailed estimated budget

Please provide a detailed budget estimate of the Cooperation Activity, indicating all the amounts in Euro according to the format € 1000,00 and add budget lines as needed. Please note that the budget of the Cooperation Activity refers to costs that organisers have to bear either directly or through the contributions of donors (in other words, costs borne directly by participants, e.g. hotel or travel, shall not be included in the budget estimate).

Please insert for each budget item:

a detailed description (e.g. accommodation for 10 participants from -name the countries- for two nights)

estimated unit cost per participant or per item of equipment or other resource (e.g. room rate per one night)

estimated subtotal related to that budget item (e.g. number of people x number of nights x room rate)

amount of the CEI contribution you request for that budget item.

Budget line	Unit cost	Subtotal	Requested CEI Funding
1. Organisation and administration
1.1. Human Resources (man hour/day/month cost as appropriate)
Subtotal 1.1.	€ 0,00	€ 0,00
1.2. National and international mission costs (expenses of organisers and partners in preparation and during the events)
1.2.1. Travel
Subtotal 1.2.1.	€ 0,00	€ 0,00
1.2.2. Accommodation
Subtotal 1.2.2.	€ 0,00	€ 0,00
1.2.3. Per diems or fees
Subtotal 1.2.3.	€ 0,00	€ 0,00
1.3. Outsourcing for external support (including pre- and post- implementation phases)
Subtotal 1.3.	€ 0,00	€ 0,00
1.4. Administrative costs (office supplies, communication, postage, website...)
Subtotal 1.4.	€ 0,00	€ 0,00
1.5. Equipment (rents or purchases of office equipment necessary for the activity implementation when different from item 4.4.)
Subtotal 1.5.	€ 0,00	€ 0,00
2. Promotion
2.1. Printing
Subtotal 2.1.	€ 0,00	€ 0,00
2.2. Text translation from/to English
Subtotal 2.2.	€ 0,00	€ 0,00
2.3. Advertising
Subtotal 2.3.	€ 0,00	€ 0,00
3. Participation
3.1. CEI Participants
3.1.1. Travel
Subtotal 3.1.1.	€ 0,00	€ 0,00
3.1.2. Accommodation
Subtotal 3.1.2.	€ 0,00	€ 0,00
3.2. CEI Speakers
3.2.1. Travel
Subtotal 3.2.1.	€ 0,00	€ 0,00
3.2.2. Accommodation
Subtotal 3.2.2.	€ 0,00	€ 0,00
3.2.3. Fees
Subtotal 3.2.3.	€ 0,00	€ 0,00
3.3. Other Participants
3.3.1. Travel
Subtotal 3.3.1.	€ 0,00	€ 0,00
3.3.2. Accommodation
Subtotal 3.3.2.	€ 0,00	€ 0,00
3.4. Other speakers
3.4.1. Travel
Subtotal 3.4.1.	€ 0,00	€ 0,00
3.4.2. Accommodation
Subtotal 3.4.2.	€ 0,00	€ 0,00
3.4.3. Fees
Subtotal 3.4.3.	€ 0,00	€ 0,00
4. Meetings and events
4.1. Catering during meeting
Subtotal 4.1.	€ 0,00	€ 0,00
4.2. Social events, study visits
Subtotal 4.2.	€ 0,00	€ 0,00
4.3. Conference material
Subtotal 4.3.	€ 0,00	€ 0,00
4.4. Meeting facilities and any audio/video equipment
Subtotal 4.4.	€ 0,00	€ 0,00
4.5. Conference interpretation services and related equipment
Subtotal 4.5.	€ 0,00	€ 0,00
5. Other expenses
Subtotal 5.	€ 0,00	€ 0,00
Total	€ 0,00	€ 0,00

4.2. Expected co-financing

Please indicate the additional sources of funding complementing the CEI financing, either coming from the organising institution, from the host country of the organisers, from other countries (CEI or third countries) or from other sources (e.g. sponsors, international organisations, NGOs etc.). Please give indication as to the status of the source of funding: please indicate C for confirmed contributions and R for requested. Please indicate as well the revenue generated through registration fees, as appropriate.

Source of co-financing	Budget items covered refer to chapters above	Status requested (R) or confirmed (C)	Amount	Of which in-kind*	% of total cost
Applicant’s resources	€ 0,00	€ 0,00
Other (specify)	€ 0,00	€ 0,00
In-kind contributions	€ 0,00	€ 0,00
Registration fees	€ 0,00	€ 0,00
SUBTOTAL CO-FINANCING	€ 0,00	€ 0,00
Requested CEI contribution	€ 0,00	€ 0,00
Total estimated cost	€ 0,00	€ 0,00

*An in-kind contribution is a non-cash, other than monetary contribution or input which can be given a cash value. Expenditures in-kind are expenditures not giving rise to an actual payment: they can take the form of

donation of goods or services, time or expertise, rather than cash or appreciated property

infrastructure support, office supplies support, equipment support etc

human resources of the organising institution.

This form was completed by:

Date:

Please do not fill-in any of the sections below

Administrative and eligibility check - rejection clauses apply	yes	no	in part
Submission
Has the Applicant respected the submission deadline?
Was the Application submitted to the correct recipients (CEI email; National Coordinator)?
Has the Applicant submitted only one application within the Call?
Is the Application filled-in correctly in all its parts?
Compliance
Is the Applicant eligible?
Is the type of activity eligible?
Is the activity in line with the objectives of the Call?
Is the activity in line with the areas of intervention?
Is the activity reflecting the objectives of a macro-regional strategy or SEE 2020?
Is the implementation date in line with the Call?
Is the participation quorum respected?
Is the budget clear and the requested CEI contribution in line with the CEI Rules?
Is the amount of the requested CEI contribution in line with the Call?
Past experience
Has the Applicant already applied for or obtained any CEI contribution?
In case of recurring applications, is the CEI past experience with the Applicant positive?

Evaluation grid	Score
1. Relevance	/ 5
To which extent does the proposed activity comply with the priorities set by CEI Plan of Action and meets with the needs of the targeted beneficiaries?
2. Quality of the information	/ 5
Is the information reported in the Application Form satisfactory?
3. Applicant’s operational capacity	/ 10
Applicant’s expertise and past experience
Invited attendance’ relevance
4. Participation	/ 10
Is the Applicant meeting the participation quorum?
Does the participation scheme comply with the regional character requested to Cooperation Activities?
5. Impact and sustainability	/ 10
Is the proposed activity suitable of contributing to meeting the envisaged goals?
Is the proposed activity likely to have a follow-up?
6. Cost effectiveness and budget coherence	/ 10
Is the budget clear, consistent and detailed, sound and cost-effective?
Is the envisaged co-financing scheme sound and effective?
7. Results/objectives	/ 15
Is the proposed activity likely to have an appropriate, practical and consistent outcome?
Impact of the activity on regional cooperation
Impact of the activity on European integration
8. Visibility, dissemination and promotion	/ 15
Is the envisaged CEI visibility adequate?
What is the quality of the promotional activities related to the action?
What is the impact of the envisaged post-implementation dissemination scheme?
TOTAL	/ 80

Comments

Final Score

00-16 not acceptable | 17-30 insufficient | 31-44 acceptable | 45-62 good | 63-80 very good

Score: Very good (5), good (4), acceptable (3), insufficient (2), not acceptable (1). Only Applications reaching a good or very good total score according to the evaluation grid below are eligible to receive possible CEI co-financing.

Score: All CEI Member States (5); more than two-thirds of CEI Member States (4); respecting the half-plus-one quorum (3); below the half-plus-one quorum (2); minimum allowed quorum (1)