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Application Form-PART A - Priority 1_3

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Application Form-PART A - Priority 1_3 Powered By Docstoc
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  ESPON 2013 Programme
  The European Observation Network on Territorial Development and
  Cohesion

  APPLICATION FORM
  PART A- Identification and financial form

1 Call details
  Call for proposal for (please select the priority first by clicking on the box and then
  choose the appropriate theme from the appearing drop down menu):
  Priority 1 - Applied
  Research Projects             o
  Priority 3 - Scientific
  Platform                      o
                   ERROR - Please select a priority. Incomplete application.

2 Project identification
           Acronym:
       (max. 50 characters)




              Title:
       (max. 250 characters)




  Colour code

          white fields                 Textfield: to be completed by the Applicant


                                       Drop-down list: to be completed by the Applicant by selecting
         green fields                  from the drop-down list

                                       not to be completed. Data are automatically
          grey fields                  transferred or calculated from another field

  The Excel protection must not be removed. Please clear all error messages
                      before submitting your application.
  Damaged applications and applications with error messages will be declared
                                 INELIGIBLE




                                          0-Cover                                           Page 1 of 29
    Table of contents
  0 Cover                                      INCOMPLETE (line 19)   ERROR (line 16)
    Instructions
  1 Financial overview                         INCOMPLETE (line 14)
1.6 Specification of budget line 4
    'Equipment'
1.7 Specification of budget line 5 'External
      experience'
1.8 Specification of budget line and work
                                               INCOMPLETE (line 6)
      packages
1.9   Payment forecast                         INCOMPLETE (line 6)
  2   Working hours
  3   Structure of management                  INCOMPLETE (line 7)
  4   Description of Partnership               INCOMPLETE (line 7)
  5   Consistency                              INCOMPLETE (line 20)   ERROR (line 9)
  6   Lead partner certification signature
                                                                      ERROR (line 14)

  7 Check list for submission                                         ERROR (line 37)




                                                  0-Cover                               Page 2 of 29
GENERAL INSTRUCTIONS FOR FILLING IN THE APPLICATION FORM

Before filling in this form, please also read all programme related documents, especially:
1) the ESPON 2013 Operational Programme and
2) the Programme Manual.
In particular, the Programme Manual will provide you with further guidance on the way to develop an
ESPON project and to prepare the application. The two above mentioned documents are available on the
programme web site (www.espon.eu).

The Application consists of
- an Application Form Part A (this protected excel file) including its two annexes as requested in point
3.5b (management chart) and 3.6b (financial flow chart)
- an Application Form Part B (separate word document)
- Solvency documents , in case you have private partners involved in the partnership (please consult the
"Member and Partner States Document Requirements for the Solvency Check of Private Applicants" and
the Application Pack for the relevant solvency related documents)

The application must be submitted in both, paper and electronic versions! The two versions have to
be identical.
Paper version
The Application Form (Part A and Part B) must be completed and printed out (all sheets).
Please make sure that Part A of the Application Form is dated, signed by a duly authorised representative
of the Lead Applicant, and stamped with the stamp of the Lead Applicant's institution.

Application Form Part A and Part B together with the annexes (charts on management and financial flow as
well as solvency related documents if relevant) have to be sent by mail/courier to the ESPON Coordination
Unit (CU) at the latest by the end date of the call. This will be checked through the date of the postal stamp
on the envelope. Hence please ensure that in case of request the date of sending can be justified (e.g:
registered mail, express delivery receipt...). The CU address is the following:
    ESPON Coordination Unit
    CRP HT – BP 144
    L-4221 Esch sur Alzette
    Luxembourg
    Please send TWO PAPER VERSIONS of the application: one ORIGINAL and one COPY of the original.

Electronic version
An electronic version of the completed Application Form Part A (in .xls format), Application Form Part B (in
.doc format) and the two charts as requested in point 3.5b (management chart) and 3.6b (financial flow
chart) have to be sent by email to the ESPON CU at the latest by the end date of the call to the following
address:
                                               application@espon.eu
 In order to confirm the receipt of your application, an automatic reply will be sent. Please keep carefully this
  message. In case you do not receive a confirmation message your application might have not reached the
                                                   ESPON CU.
Technical instructions
  • Before filling in Part A of the Application Form, please set your Macro security level of the excel file on
    "low". The Macros need to be enabled.




                                                   Instructions                                          Page 3 of 29
• Applicants are asked to complete all white fields of this Application Form according to the instruction
  fields.
• All white fields are the input fields. White fields are locked in order to ensure that all applicants have
  the same amount of space for describing their project and answering the questions. The number of
  characters (with spaces) is limited: maximum number of characters is marked for the fields. Any text
  exceeding this space will not be visible and therefore cannot be taken into account when assessing the
  applications.
• Green fields are drop-down lists including the possible answers. Please select from the list by clicking
  on the arrow of the cell. Copy and paste functions might result in appearing error messages in the form.
  Please avoid the cut/copy and paste functions.
• Grey fields are not to be completed. For the grey fields, certain information will automatically be
  transferred to these sections after details are entered in other fields of the Application Form. Formula
  for automatic calculations have been included in the relevant fields. These fields cannot be changed or
  edited.
• Please avoid the cut/copy and paste functions when filling in the form. You risk that invalid values
  appear in the cells which will result in error messages.
• All input fields must be filled in unless stated otherwise in the instruction field.
• Certain questions in the Application Form must be answered by marking a tick-box. When clicking on
  the box, a tick mark will appear.
• If you want to use a bullet point list in any of the input fields, please press ‘Alt+Enter’.
Application Forms with error messages or with uncompleted fields will automatically be declared
   ineligible. Please clear all error messages in the cover sheet and in all other sheets before
                                     submitting your application.




                                               Instructions                                        Page 4 of 29
SECTION 1 Financial overview

  1.1 Application under



  1.2 Project identification
      Acronym:
     Title:




  1.3 Duration

     Please indicate when the operation will start and finalise its activities. Concerning the start
     date, the following elements should be taken into consideration. Decisions on projects are
     expected to be taken within three months after the end date of each call. Projects should
     therefore be ready to start implementation immediately after the date of approval of the
     operation. For the recommended duration of projects, please refer to the Project
     Specification/Programme Manual relevant sections related to the different priorities.
     Please refer to the time schedule that is indicated in the project specification: dates must
     comply with the indicated time schedule.

                                       Start of the project                         (dd/mm/yyyy)
                                 Closure of the activities                          (dd/mm/yyyy)
                     Closure of the administrative duties




                                            1-Financial overview                                       Page 5 of 29
1.4 Partnership information
    ESPON projects are generally conducted in a partnership of several bodies from at least
    three EU Member and Partner States (from three different countries taking part in the
    ESPON 2013 Programme).
    However this requirement does not apply to projects with a budget up to € 200.000,00.
    The table below will be filled in automatically. Please start by filling in section 1.5.
                                                          Member/ Partner             Total budgeted
    Partner
N.                                                        State                       costs
1
    Total                                                                                       € 0.00




                                           1-Financial overview                                          Page 6 of 29
1.5 Partnership details

   Lead Partner
   Name of the institution in original language
   Name of the institution in English
   Legal status
   Address
   Code
   Town
   State
   Location according to NUTS II
   Web site
   Mail
   Bank
   Name of the bank
   IBAN
   SWIFT/BIC
   Address of the bank
   Town
   Code
   State
   Holder of the account
   Internal reference for the account (if needed)            df
   VAT status
   The partner is a VAT payer and cannot recover
   VAT ( consult chapter 8.4.5 of Programme
   Manual)
   (If yes, please make sure all budgeted costs are
   VAT inclusive)

   Budget of the Lead Partner (in Euro)
   Please indicate here the budget for this partner. You can include in the budget also all the preparation
   costs incurred from the pre-announcement of the call to the date of submission of the Application
   Form.
   Total eligible cost

   Financing rate requested from the Programme                                  100%
   Total financing requested from the Programme                                 € 0.00




                                             1-Financial overview                                             Page 7 of 29
      0              1
1.6       Specification of budget line 4 ‘Equipment’
          This budget line refers to the depreciation of equipment necessary for the successful implementation of
          the project. This category usually refers to IT equipment such as a computer or a printer necessary for
          project activities and management. Project partners should already have the necessary equipment to
          implement the activities described in the Application Form, the purchase of equipment should remain
          exceptional. The breakdown for this budget line has to be specified here: the nature of the equipment to
          be depreciated, the partner responsible for it, the budget for the depreciation allowances (in euro).
          Please remember that only depreciation allowances can be financed and not the full cost (see
          Programme Manual chapter 8.4.2).




                            Description of the equipment           Partner                Amount (EUR)


                                                                                                                               0
                                                                                                                               0
            Workpackage 1
             Coordination




                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                              Subtotal                                          0.00
                                                                                                                               0
                                                                                                                               0
            Workpackage 2




                                                                                                                               0
              Activities




                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                              Subtotal                                          0.00
                                                                                                                               0
                                                                                                                               0
            Workpackage 3
            Dissemination




                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                                                                                               0
                                                              Subtotal                                          0.00
                            TOTAL Workpackages                                                                  0.00
                                                                                                                               0

                                             1.6-Breakdown BL4 Equipment                                               Page 8 of 29
  0                       1
1.7 Specification of budget line 5 ‘External expertise and services’

      Please specify the costs that you have budgeted for this budget line: describe the cost item briefly and
      state the amount (in euro). Please indicate the partner that is going to take over the contracting
      procedure and pay for the cost. Please be aware that public procurement procedures must be
      complied with, when contracting an external expert or a supplier (refer to Programme Manual chapter
      8.4.2.and 8.4.4.)



                                Description of external expertise /    Contracting
                                                                                          Amount (EUR)
                                   services to be contracted            Partner
         1 Coordination
         Workpackage




                                                                      Subtotal                            0.00
         Workpackage
          2 Activities




                                                                      Subtotal                            0.00
       Dissemination

       Workpackage
            3




                                                                      Subtotal                            0.00
                              TOTAL Workpackages                                                          0.00




                                              1.7-Breakdown BL5 External exp                                     Page 9 of 29
               1




0
0
0
0
0
    F9:F59
0
0
0
0
0
    F61:F120
0
0
0
0
0
    F122:F170
1
0




                   1.7-Breakdown BL5 External exp   Page 10 of 29
  1
1.8         Breakdown budget line and workpackage


      Please break down the costs per budget line (BL) in correspondance to the Workpackages (WP) below.
      Please include also the budget for the preparation costs. Preparation costs, as described in section 8.4.1 of the Programme Manual are the costs
      incurred by the partnership from the date of the pre-announcement of the call (publication in the Official Journal) to the date when the Application
      Form is sent to the ESPON Coordination Unit. Preparation costs can only be included in the following budget lines: Staff, Administration, Travel
      and accomodation, External expertise and services. Please consult chapter 8.4.2 of the Programme Manual for the different thresholds to be
      considered when planning Administration costs.
      Workpackage 1 Coordination: please insert here the budget for coordination activities only.
      Workpackage 2 Activity: please insert here the budget for the content related activities foreseen in the project.
      Workpackage 3 Dissemination: please insert here the budget for dissemination activities only (Under Priority 4 the budget for dissemination
      activities are to be included in Workpackage 2).
      The calculation of staff budget has to be based on the number of working hours foreseen for the implementation of the activities.
      Please make sure to complete sheet 2 "Working hours".

            Breakdown budget line/ Workpackage 1          Workpackage 2     Workpackage 3
            workpackage               Coordination        Activity          Dissemination       Total
            1. Staff                                                                                                                              € 0.00
            2. Administration                                                                                                                     € 0.00
            3. Travel and
            accomodation                                                                                                                          € 0.00
            4. Equipment                           € 0.00            € 0.00              € 0.00                                                   € 0.00
            5. External expertise and
            services                               € 0.00            € 0.00              € 0.00                                                   € 0.00
            Total                                  € 0.00            € 0.00              € 0.00                                                   € 0.00




                                                                                 1.8-Breakdown BLWP                                                          Page 11 of 29
1.9    Payment forecast

       Please provide in the table below the expected amounts to be paid and reported for each claim.
       Each payment claim covers a six-month period. Please note that you can also claim funds in less than six claims, according to the recommended duration of the
       project, mentioned in the Project Specification/Programme Manual. In case there is no cost foreseen for a period, please include "0" to eliminate error message
       appearing in the Cover sheet.
  A)         Programme contribution
                            1st claim                  2nd claim           3rd claim          4th claim           5th claim          6th claim           Total
       Value of the payment
       claim (in euro)                                                                                                                                               0.00
       %



  B)        Partner States' contribution
                              1st claim                2nd claim           3rd claim          4th claim           5th claim          6th claim           Total
       Value of the payment
       claim (in euro)                                                                                                                                               0.00
       %


A+B         Total funding
                                   1st claim           2nd claim           3rd claim          4th claim           5th claim          6th claim           Total
       Value of the payment
       claim (in euro)                          0.00                0.00               0.00                0.00               0.00                0.00               0.00
       %




                                                                                 1.9-Payment forecast                                                                       Page 12 of 29
1
    SECTION 2 - Overview of working hours

    Please include an overview of working hours foreseen by Lead/Project Partners and in total for the implementation of the project.
    Please make sure that the calculation of staff budget (section 1.8 of this Part A of the Application Form) is based on the number of
    working hours foreseen for the implementation of the activities.

    Please make the calculation in working hours. No other unit will be accepted.


    Nr.                            Lead/Project Partner name                                      Number of working hours foreseen
          1
                                                 Total                                                                                     0.00




                                                                                    2-Working hours                                               Page 13 of 29
             0
SECTION 3        Project management structure
                 Please provide the details of the following actors in the project management
                 structure. Each operation has to appoint or sub-contract a Project Coordinator
                 and a Financial Manager, while the appointment of a Project Manager and a
                 Communication Manager is optional.
            3.1 Project coordinator
                The role of the coordinator is to put together and coordinate the contribution of
                the partners, in terms of content, but he/she is also in charge of the overall
                management of the project (partnership, agreements, contents…). Please
                refer to section 8.3.4 of the Programme Manual.
                 Contact person
                 Institution
                 Address
                 Postal code
                 Town
                 Country
                 Phone (office)
                 Fax
                 E-mail
                 Experience
                 (max 1000
                 characters)




                                           3-Management structure                                   Page 14 of 29
3.2 Financial manager
    The financial manager is in charge of the financial and control system of the
    project (budgeting, reporting, audit trail, support to the partners in financial and
    audit/control matters). Please refer to section 8.3.4. of the Programme Manual.

    Contact person
    Institution
    Address
    Postal code
    Town
    Country
    Phone (office)
    Fax
    E-mail
    Experience
    (max 1000
    characters)




                                 3-Management structure                                    Page 15 of 29
3.3 Communication manager
    This manager is responsible for the overall dissemination activities of the
    project.
    Contact person
    Institution
    Address
    Postal code
    Town
    Country
    Phone (office)
    Fax
    E-mail
    Experience
    (max 1000
    characters)




                               3-Management structure                             Page 16 of 29
3.4 Project manager
    In case the project coordinator is assisted by a project manager, for more
    operational tasks, please fill in also this section with the data of the project
    manager.
    Contact person
    Institution
    Address
    Postal code
    Town
    Country
    Phone (office)
    Fax
    E-mail
    Experience
    (max 1000
    characters)




                                 3-Management structure                                Page 17 of 29
3.5 Management structure
  a Please describe the management structure of the project: if project partners
    are involved, please provide details on the partnership cooperation
    agreements that will be set up and on the partnership coordination set-up.
    Please describe also the procedures for project management, decision making
    and monitoring of the project. (max 1000 characters)




 b Please provide a chart or diagram to visualize interlinkages in relation to
   the management and decision making process of the project. Please
   attach this document to the present application (both in digital and paper
   version)

 d Please describe the Lead Partner experience in project management and
   coordination. (max 2000 characters)




                             3-Management structure                                Page 18 of 29
3-Management structure   Page 19 of 29
3.6 Financial flow and audit trail
  a Please describe the internal reporting, the financial management and the
    controlling structures of your project with particular emphasis on the audit trail,
    on how the accounts will be handled (maximum 2000 characters) .




                                3-Management structure                                    Page 20 of 29
b Please provide a diagram or a chart to illustrate the financial flow and the
  audit trail. Please attach this document to the present application (both in
  digital and paper version)
c Please indicate in particular the responsibilities for the overall management of
  the partnership and for the filing and tracing of the project financial and
  administrative documentation. (max 1000 characters)




                             3-Management structure                                  Page 21 of 29
3.7 Previous experience in territorial cooperation and Structural Funds
    Please describe the previous experience of the Lead Partner and Project
    Partners (if relevant) in territorial cooperation projects and in Structural Funds
    financed projects. (max 2000 characters)




                                3-Management structure                                   Page 22 of 29
             0
SECTION 4        Scientific quality of the Project Partnership



            4.1 LP experience in project management of scientific projects
                 Please describe the Lead Partner's experience in the project management of scientific projects. (max
                 2000 characters)




            4.2 Partnership scientific experience
                 Please list the scientific competences and expertise of the Lead Partner and Project Partners (if
                 relevant) in the field of the project, such as academic and professional background related to the theme
                 and methodologies of the project.
                 Lead Partner (Maximum 1.000 characters)
              0 0
                Consistency of the project with EU horizontal policies: equal
SECTION 5       opportunities and environmental sustainability

            5.1 Equal opportunities
                In order to tick the boxes here underneath, please just move your mouse over the
                cell and click with the left button of your mouse. A tick will appear automatically. Do
                not put any digits into the boxes.
                Please state if the project will:
                      o          have its main focus on equal opportunities
                      o          be positive in terms of equal opportunities
                      o          be neutral in terms of equal opportunities
                                ERROR - Please tick one
            5.2 Environmental sustainability
                In order to tick the boxes here underneath, please just move your mouse over the
                cell and click with the left button of your mouse. A tick will appear automatically. Do
                not put any digits into the boxes.
                Please state if the project will:
                      o          have its main focus on environmental sustainability
                      o          be positive in terms of environmental sustainability
                      o          be neutral in terms of environmental sustainability
                                ERROR - Please tick one

            5.3 Consistency of the project's THEME with EU horizontal policies


                Please explain how the theme tackled by your project will address directly or
                indirectly each of the two EU horizontal policies. (Maximum 1.000 characters)




                                              5-Consistency                                               Page 25 of 29
5.4 Consistency of the project's IMPLEMENTATION with the EU
    horizontal policies

    Please explain how your project will address (directly or indirectly) each of the two EU
    horizontal policies in its implementation phase (Maximum 1.000 characters)




                                  5-Consistency                                                Page 26 of 29
        0
SECTION 6        Confirmation, certification and signature of the Lead Partner
                 In order to tick the boxes here underneath, please just move your mouse over the cell and click
                 with the left button of your mouse. A tick will appear automatically. Do not put any digits into
                 the boxes
                 By signing the Application Form the Lead Partner confirms that:
        1 o      All the partners listed in the present application match the definition of
                 beneficiary (legal status) reported in the Programme Manual, section 8.1.
        2 o      All the partners listed in the present application have the financial,
                 administrative and technical capacity for taking part in the project.
        3 o      All partners listed in the present application form are committed to take part in
                 the project activities.
        4 o      The expenditure of the project, if approved and funded by the Programme,
                 will not receive assistance from any other Community financial instrument (
                 Art. 54(5) of Council Regulation (EC) No 1083/2006).
        5 o      The project does not contravene EU legislation in particular rules applying to
                 the eligibility of the expenditure of Structural Funds support, to competition
                 policy, to state aid, to environmental rules and to equal opportunities.

        6 o      All partners are aware and have agreed on complying with the rules applying
                 to the eligibility of the expediture of Structural Funds support, to competition
                 policy, to state aid, to environmental rules and to equal opportunities.

        7 o      All partners are aware and have agreed on complying with the formal
                 requirements stated in the Project Specifications (for Priorities 1-3) /
                 Programme Manual (for Priorities 1-4).
        8 o      Sufficient publicity will be accorded to the implementation of this EU funded
                 project in compliance with the Programme Manual section 8.4.6 and
                 Commission Decision 94/342/EC in order to attract the attention of potential
                 recipients of the Community assistance and to increase the public's
                 awareness of the Community role in financing the project.

            ERROR - All boxes must be ticked!


SIGNATURE

STAMP
NAME AND POSITION
WITHIN LEAD PARTNER
ORGANIZATION

DATE AND PLACE




                                             6-LP certification signature                                           Page 27 of 29
SECTION 7 Cheklist for submission
           In order to tick the boxes here underneath, please just move your mouse over the cell and click with the left button of your mouse. A
           tick will appear automatically. Do not put any digit into the boxes.
         0 Please make sure that you have fulfilled the requirements listed below before submitting the documents.

                     The paper Application Form Part A is signed, dated and stamped by an authorized representative of
                o
                     the Lead Partner.

                  TWO PAPER VERSIONS of the completed Application Form Part A (excel file), completed
                  Application Form Part B (word document) and the relevant annexes: one ORIGINAL and one COPY
                o
                  of the original are submitted to the CU by the end date of the calls at the latest (date of the post
                  stamp).

                  One electronic version of the completed Application Form Part A (in xls format) together with the
                  charts as required in points 3.5b and 3.6b, Application Form Part B (in doc. Format) are submitted via
                o
                  e-mail to application@espon.eu by the end date of the call at the latest.


                o Identical applications are submitted in the electronical and paper version.

                     The paper and digital versions of Part B are anonymous and do not include any reference to the Lead
                o
                     Partner, partner institutions, experts involved or any other identifying reference.

                o All documents (except the solvency related documents - if relevant) are in the working language of the
                  Programme (English).
                     The paper versions (one original and one copy) of the application are sent in one single
                o
                     package/envelope.

                o The compulsory annexes for private partners (solvency related documents) are enclosed in paper
                  version (if relevant).
                o All partners participating in the operation are listed in the Application Form Part A with their
                  institution’s name in original and English languages.
                  The applicant has verified the compliance of the application with the eligibility criteria of the ESPON
                o 2013 programme described in the Programme Manual and in the text of the call.


                     The applicant has verified that all fields have been filled in and no error messages appear.
                o

                  The chart describing the interlinkages in the management structure, as required by 3.5
                o b), is annexed to the present application, both in digital and paper version.


                  The chart describing the audit trail, as required by 3.6 b), is annexed to the present
                o application form, both in digital and in paper version.




                     ERROR!! All boxes must be ticked!




                                               7-Check list for submission                                           Page 28 of 29
e left button of your mouse. A




 horized representative of


le), completed
IGINAL and one COPY
st (date of the post


 at) together with the
Format) are submitted via




any reference to the Lead
ce.

e working language of the

n one single


are enclosed in paper


art A with their

y criteria of the ESPON
call.


sages appear.




                                 7-Check list for submission   Page 29 of 29

				
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