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CEI Cooperation Fund
Application Form
for Funding
a CEI Cooperation Activity
Submitted by
Please indicate only the name of the submitting institutions
Via the CEI National Coordinator of
Please indicate the name and country of the CEI National Coordinator you have contacted
Part 1 General Information
1.1. Title of the Cooperation Activity
1.2. Applicant
Please add a brief description of your organisation
1.3. Short description of the Cooperation Activity
Please provide a short description of the Cooperation Activity you are proposing (max 2000 characters)
1.4. Intended date and place of implementation
Please refer to the exact date of implementation of the project. The preparatory and post-implementation phases shall be defined as appropriate
Part 2 Description of the Cooperation Activity
2.1. Detailed description
Please provide a detailed description of the various preparation and implementation phases of the Cooperation Activity (max 5000).
2.2. Background of the project
Please indicate if this is an original project idea of yours, or if the project originates from a CEI Working Group or another source. Moreover, you should state whether this is a one-time or a periodically recurring event.
2.3. Participation
Please indicate the envisaged number and role of participants in the Cooperation Activity, which country, institution or international body they belong to, if a registration fee is requested and what does the fee cover. Please indicate as well special arrangements made to facilitate the participation of non-EU CEI countries. Please provide a list of contacts with full details.
CEI Member States and envisaged number of participants
AlbaniaAustria BelarusBulgariaBosnia and HerzegovinaCroatiaCzech RepublicHungaryItalyMacedoniaMoldovaMontenegroPolandRomaniaSerbiaSlovakiaSloveniaUkraineTOTALOther countriesInternational bodies or institutions
Registration fee (applied / not applied )
if applied
Amount ______ EUR
Expenses/budget lines covered by the registration fee ______
2.4. Compatibility with the CEI Plan of Action
Please indicate to which relevant chapter of the Plan of Action the activity refers and in which respect it helps in meeting its goals.
2.5. CEI visibility
Please indicate how you intend to ensure visibility to the CEI within the Cooperation Activity (e.g. make reference to the use of the CEI logo). Please indicate as well how you intend to promote the Cooperation Activity.
2.6. Expected results
Please indicate the expected outcome of the Cooperation Activity. Please indicate, as appropriate, which publications or material you intend to prepare before and after the Cooperation Activity.
2.7. Involvement of CEI Bodies
Please indicate which CEI bodies, if any, you intend to involve in the preparation and implementation of the Cooperation Activity.
Part 3 Organisation and administration
3.1. Person responsible for the implementation of the Cooperation Activity
Please provide the contact details of the person that is in charge of the organisation and implementation of the Cooperation Activity.
First Name and Family NameOfficial positionInstitutionAddressTelephoneFaxEmailWebsite
3.2. Person responsible for expenditures related to the Cooperation Activity
Please provide the contact details of the person that is in charge of the financial management of the Cooperation Activity and that will be responsible for the accounting of the Activity. Please note that this person cannot coincide with the one responsible for the implementation.
First Name and Family NameOfficial positionInstitutionAddressTelephoneFaxEmailWebsite
Part 4 Budget
Total budget estimateTotal budget estimateEUR (100%)Requested CEI contributionEUR___ % of the total budget estimateApplicants own resourcesEUR___ % of the total budget estimate
Total budget estimate of the CEI Cooperation ActivityPlease provide a detailed budget estimate of the Cooperation Activity, indicating all the amounts in EUR (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 CEI countries for two nights) the estimated unit cost per participant or per item of equipment or other resource (e.g. room rate per one night) the estimated subtotal related to that budget item (e.g. number of people x number of nights x room rate) the amount of the CEI contribution you request for that budget item. Please refer to the CEI Rules for Allocation B6, B7 and B8 for information on the use of CEI contribution and eligible budget items.No. Expenditures# of UnitsUnit CostSubtotalCEI Funding1. Organisation and administration1.1.Human resourcesManagement, consultants, experts (please specify in the budget line whether the cost is monthly or daily, e.g. project coordinator 1 month)Subtotal1.2.Travel expenses(international travel, local transportation)Subtotal1.3.Accommodation (hotel rooms)Subtotal1.4.Allowances, per diems, mealsSubtotal1.5.Contracts and subcontracts(when applicable)Subtotal1.6.Equipment(rent of rooms/offices when different from the organising institution headquarters, conference rooms, furniture, computers, audiovisuals)Subtotal1.7.Administrative costs(office supplies, communication...)Subtotal2. Promotion2.1.Publications(design, printing, distribution, translation...)Subtotal2.2.Advertising(when applicable)Subtotal3. Meetings and conferences3.1.Participants(please refer exclusively to the costs to be borne by the organisers)Travel costs(travel costs, means of transport, visa costs if applicable)SubtotalAccommodation(please indicate the room rate and the number of nights)SubtotalSubsistence costs(meals, per diems if applicable)Subtotal3.2.Speakers / lecturers / trainers / experts(please refer exclusively to the costs to be borne by the organisers)Travel costs(travel costs, means of transport, visa costs if applicable)SubtotalAccommodation(please indicate the room rate and the number of nights)SubtotalSubsistence costs(meals, per diems if applicable when different from catering)SubtotalFees(please specify if comprehensive or daily)Subtotal3.3.Interpretation(during the meetings)Subtotal3.4.Catering(lunches, dinners, coffee breaks during the meetings)Subtotal3.5.Excursions, study visits, social events(if applicable)Subtotal3.6.Training material(conference kits, pens..)Subtotal3.7.Meeting facilities and equipment(rent of room, furniture, computer equipment, audiovisuals)Subtotal4. Other(if applicable)SubtotalTOTAL ESTIMATED BUDGET
Expected sources of funding
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-financingBudget items covered by the contributionR/CAmount EURof which in-kindApplicantHost countryOther countriesOther sources of funding (sponsors)In-kind contributionsRegistration fees revenueSubtotal co-financingRequested CEI contributionTOTAL ESTIMATED COST
* * *
This form was completed byDate
CEI SECRETARIAT EVALUATION
Activity in line with the CEI Plan of Action
Involvement of non-EU CEI countries
Involvement of CEI bodies and visibility given to the CEI
Recommendation by the CEI Secretariat
Proposed financial allocation from the CEI Cooperation Fund
Other potential sources of funding
Submitted to the Committee of National Coordinators for decision
To be completed by the CEI-ES
Ref. No.: 1202.XXX-XX
Received on: XX/XX/XXXX
Country:
Area of activity:
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