Application Form
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Den leeren Antrag für eine Jugendinitiative findet ihr unter http://www.snj.lu/fr/04-programme-jeunesse/formulaires/03_initiative-jeunes/index.html
Mit diesem Antrag könnt ihr Geld für eure Jugendinitiative beantragen.
Application
for
YOUTH programme
Action 3
YOUTH INITIATIVES
Group Initiatives
Networking Projects
Part I. Project identification and summary
Title of your proposed project
Please give a short title to your project.
Type of activity
Please tick the box(es) corresponding to the project for which you are submitting this application. Type of activity :
0 Group initiative
0 Networking project 0 Crossborder cooperation (Networking projects only)
Duration of your project
Please indicate the total duration of the project from preparation to evaluation ( = eligible period for costs linked to the project, please consult the User’s Guide section B.5 for the exact dates). The project starts : (date when the first costs incur) 01 / 05 / 2006 The project ends : (date when the last costs incur) 18/ 08 / 2006
Total duration of the activities (in months) : X month
Place where the project will take place Address Postcode Region Country Luxembourg
Main themes for the activities
Please tick not more than 2 boxes.
- 0 Art and culture
- 0 Social exclusion (in general)
- 0 Environment
- 0 Measures against delinquency
- 0 Heritage protection
- 0 Youth information
- 0 Rural development
- 0 Youth policies
- 0 Urban development
- 0 Youth leisure
- 0 Equal opportunities
- 0 Youth sports
- 0 Anti-racism/xenophobia
- 0 Media and communications
- 0 Health
- 0 European awareness
- 0 Anti-drugs/substance abuse
- 0 Other
Summary of your project
Please give a short description of your project (approximately 50 words).
Inclusion: special considerations and other information
Does your project involve young people with fewer opportunities (from a less-privileged cultural, geographical or socio-economic background, or with disabilities) and/or special needs (e.g. additional preparation and support, mobility problems, health care, special premises etc.)? If so, please describe.
Part II. Applicant
A. Details of the applicant organisation / group
Name
Street address
Postcode
Region Country Luxembourg
Email Website
Telephone
Person authorised to sign the contract on behalf of the applicant (legal representative) Family name (Mr/Ms) First name Position/function
Person in charge of the project (contact person) Family name (Mr/Ms) First name Position/function Email
Telephone Telefax
B. Profile of the applicant organisation / group
Status 0 governmental / public 0 non-governmental 0 other
Activity level
0 local 0 regional 0 national 0 international 0 European level non-governmental organisation (with member organisations in at least 8 Programme countries)
Please give a short description of your organisation/group
(regular activities, member of, etc.) :
Has your organisation/group already organised similar activities or received a grant from the European Commission?
0 No +0 Yes, YOUTH - specify reference of the most recent contract : 0 Yes, other - specify :
C. Details of your support organisation and/or adviser (if applicable)
If you have an organisation and/or adviser supporting you with your activities, please provide contact details. Support organisation Name Street address Postcode City Region Country Email Website Telephone Telefax
Profile of the support organisation Type 0 organisation or association 0 group
Status 0 governmental / public 0 non-governmental 0 other
Activity level 0 local 0 regional 0 national 0 international 0 European level non-governmental organisation (with member organisations in at least 8 Programme countries) Please give a short description of the organisation (regular activities, member of, etc.) :
Has the organisation already organised similar activities or received a grant from the European Commission?
0 No
0 Yes, YOUTH - specify reference of the most recent contract :
0 Yes, other - specify :
Adviser
Family name (Mr/Ms) First name
Street address
Postcode City
Region Country
Telephone Email
Part III. Partner organisation(s) / group(s) (for Networking projects only)
Please fill in this page for each of your partner organisation(s) / group(s).
A. Details of the partner organisation / group Name Street address Postcode City Region Country Email Website Telephone Telefax
Person in charge of the project (contact person) Family name (Mr/Ms) First name Position/function Email Telephone Telefax
B. Profile of the partner organisation / group Type 0 organisation or association 0 group
Status 0 governmental / public 0 non-governmental 0 other
Activity level 0 local 0 regional 0 national 0 international 0 European level non-governmental organisation (with member organisations in at least 8 Programme countries)
Please give a short description of your organisation/group (regular activities, member of, etc.) :
C. Preliminary agreement of the partner organisation / group
I, the undersigned, on behalf of (repeat the name of the partner organisation / group)
confirm our willingness to participate in the preparation, implementation and evaluation of the networking project (repeat the title of the project as stated in Part I)
as well as our commitment to ensure visibility of the European Union support for the activities and/or the production of materials and to encourage the participants to initiate new youth activities. Name in capital letters : Place, date : Signature :
Part IV. Participants in the project
Please note that, in principle, only young people aged between 15 and 25 can participate in the YOUTH programme.
A. Information on the young people directly involved in the project
Country of residence Total number of young people Distribution by gender Distribution by age group Male Female < 15 15-17 18-25 > 25
TOTAL
B. Special considerations and other information If there is anything else you would like to add regarding your group and/or your project, please write it down here.
Part V. Project description
Please consult the User’s Guide, chapter E. The points below are intended to serve as a guide for your description of the proposed activities. The information that is requested will be very important in the selection process, and later for the running of the project. In particular, please explain how you are involved in each stage of the project: preparation, realisation and evaluation.
A. Context and motivation
Please explain:
how you came up with the idea of your project,
why you are willing to do it.
B. Preparation
Please explain what kind of preparation (meetings, activities, etc.) you have done and will do to prepare this project:
within your own group,
with your partner group(s) for a networking project.
C. Involvement of participants
Please describe how the young people will be actively involved in the different phases of the project:
preparation,
realisation,
follow-up/evaluation.
D. Involvement of your support organisation and/or adviser (if applicable)
Please describe the involvement of your support organisation and/or adviser during the different phases of the project in relation with e.g.:
training for young people before the setting up of the project,
administrative support during the preparation of the project,
personal or/and technical support during the realisation of the project,
meeting young people after the implementation of the project to help them to evaluate and follow-up the project.
E. Objectives
Please describe what you expect to achieve with this project in relation with e.g.:
the personal development of the young participants,
the involvement of other young people and/or the local community,
the new experience for the participants and the local community involved,
the priorities of the YOUTH programme (please see the User’s Guide, section A.2).
F. Beneficiaries
Who will benefit from this project, in addition to the participants directly involved?
G. Impact at local level
What is the impact of your project at the local level? Please explain how you plan to involve the local community in your project.
H. European dimension
Please describe the European dimension of your project (please see the User’s Guide, section E.2).
I. Activity programme
Please describe which concrete activities will be put into practice, and how these meet the objectives. Please attach a work plan.
J. Follow-up and evaluation
How do you plan to evaluate and follow-up this project? Please give details in relation with e.g.:
how to capitalise on the project’s impact,
follow-up activities,
the possibilities of setting up a networking project after implementing a group initiative?
Part VI. Budget
All items in euros
For further information please consult the User's Guide for the overview of funding rules and the fixed amounts set out by your National Agency.
Accepted costs
(to be filled in by the National Agency)
Estimated costs Total
Please state clearly the type of estimated costs directly linked to the project (material, equipment, rental costs, etc.).
