NANDO PERETTI FOUNDATION � APPLICATION FORM by I14TpTUD

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									                  THE NANDO PERETTI FOUNDATION
                        APPLICATION FORM

                            (please write outside the boxes)

Name of the applicant
(complete name of the organization)




Title of the project
(the title has to be clear and descriptive of the goals of the project proposal. Please,
avoid any acronym)




Date of submission




                                               Dossier No.

                                              (for official use only)
                                              application_form_eng_87.doc
I - Your organization


Organization's legal name (and legal name of parent organization, if any)


Legal status and nationality
(E.g. Non-profit association, Onlus, etc. The Statutes must make it possible to ascertain
that the organisation was set up by an act governed by the national law of the
nationality country)


Complete organization's legal address (and correspondence address if different)


Organization's phone number, fax number, email and website (if any)


Name and title of the legal representative (name and title of the person legally in
charge to sign the contract)


Name and title of the principal contact person
(Please, indicate email and mobile number, if any)


Organization's achievements related to the project issue
(a brief description of your organization as well as other information to help us
understand why the organization is qualified to undertake the project.)


II - The issue addressed




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Name of the proposed project


Background information
(the problem you propose to address, including evidence of its importance and relation
with the Foundation's goals)


Explanation of how the project will address the problem: activities, operational
procedures and methodology


Anticipated achievements or outcomes of the project
(Including a description of multiplier effects, if any)


Description of how the results will be disseminated


Sustainability
(Explanation of how the applicant organization will sustain the project financially
after the Foundation funding has ended)


III - The time and geographic frame

Project timetable
(Please, insert a timetable of the activities and indicate when the project should start
and end)


Country or geographic region where the work will take place




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IV - The anticipated costs

Estimated costs for the project in EUR


Amount requested from Nando Peretti Foundation in EUR


Detailed budget
(Please, provide a detailed budget in a separate Excel file)

Timing of the costs


Bank Account
(Please, provide us with full details on your Bank Account, including IBAN or SWIFT
code. Note that the account holder must be the proponent organization)

Name of the Bank:
Address of the Bank:
Account number:
Account holder:
SWIFT code:
IBAN code:




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