SEE Programme
Document reg. no.:
Application Form
1. Project Identification
1.1. Main data
Call for proposal ID
B
Project acronym
Project title
Application ID
EoI Reference number
Priority Axis
Area of Intervention
1.2.Project summary
Project Lead Partner
(official name in English)
Lead
Partner’s
country
1.3. Project duration
From month/year
To month/year
Duration
This document has been generated automatically based on the data recorded until 28/03/2011 9:06 AM
1/8
2. Partnership
2.1. List of Project Partners (insert details of MN IPA partner (s))
Partner role
Official name in English
Abbreviation
Country
2.2.1 MN IPA FLP
In case you have more than one IPA partner (Financial IPA lead Partner) please insert details for another
MN IPA partner
2.2.1.1. Legal Identification Data
Official name in English
Full name in original
language
Abbreviation
Country
Type of institution
Legal status
National tax number
Registry number
Official address
Phone
Mobile
Fax
e-mail
Homepage
Legal representative
Name of the
representative
legal
Position
of
representative
legal
Phone
Mobile
Fax
e-mail
2.2.1.2. Partner data in the project
Contact Person
Name of contact person
in project
Position of contact
person in project
Phone
Mobile
Fax
e-mail
2.2.1.3. Relevance of the proposed MN IPA partner in this project
2.2.1.4. Description of previous experience in Interreg and other relevant EU funded projects of MN IPA
partner
4. Work packages and activities
4.0. wp1 – Transnational project and financial management
Add as many activities (rows) as needed or delete as many activities (rows) if needed
4.0.1.Work Package Main Data
Title
Responsible Partner
4.0.4. IPA partners activities in the Work package
act 1.1
Description of MN IPA partners activities in
the Work package
Role of MN IPA partner
Amount
Geographical location
Timeframe
act 1.2
Description of MN IPA partners activities in
the Work package
Role of each MN IPA partner
Amount
Geographical location
Timeframe
Add as many outputs / results as needed
4.0.6. Qualitative and quantitative description of the outputs and results (only outputs and results with
reference to the activities to be carried out by the MN PP)
Type
Description
Partner
Contributing
Partner
Measuremen
t unit
Base
value
Target
value
Period of delivery
output
output
output
output
output
result
result
result
result
result
4.1. wp2 – Communication activities
Add as many activities (rows) as needed or delete as many activities (rows) if needed
4.1.1.Work Package Main Data
Title
Responsible Partner
4.1.4. IPA partners activities in the Work package
act 2.1
Description of MN IPA partners activities in the Work
package
Role of MN IPA partner
Amount
Geographical location
Timeframe
act 2.2
Description of MN IPA partners activities in the Work
package
Role of MN IPA partner
Amount
Geographical location
Timeframe
Add as many outputs / results as needed
4.1.6. Qualitative and quantitative description of the outputs and results (only outputs and results with
reference to the activities to be carried out by the MN PP)
Type
Description
Partner
Contributin
g Partner
Measuremen
t unit
Base
valu
e
Targe
t
value
Period of delivery
output
output
output
output
output
result
result
result
result
4.2. wp3 – Content
Add as many activities (rows) as needed or delete as many activities (rows) if needed
4.2.1.Work Package Main Data
4.2.4. IPA partners activities in the Work package
act 3.1
Description of MN IPA partner activities in the Work
package
Role of MN IPA partner
Amount
Geographical location
Timeframe
act 3.2
Description of MN IPA partners activities in the Work
package
Role of MN IPA partner
Amount
Geographical location
Timeframe
4.2.6. Qualitative and quantitative description of the outputs and results (only outputs and results with
reference to the activities to be carried out by the MN PP)
Type
Description
Partner
Contributing
Partner
Measuremen
t unit
Base
value
Target
value
Period of delivery
output
output
output
output
output
result
result
result
result
result
result
4.3. wp4 – Content
Add as many activities (rows) as needed or delete as many activities (rows) if needed
4.3.1.Work Package Main Data
Title
4.3.4. IPA partners activities in the Work package
act 4.1
Description of MN IPA partners activities in the Work
package
Role of MN IPA partner
Amount
Geographical location
Timeframe
act 4.2
Description of MN IPA partners activities in the Work
package
Role of MN IPA partner
Amount
Geographical location
Timeframe
4.3.6. Qualitative and quantitative description of the outputs and results (only outputs and results with
reference to the activities to be carried out by the MN PP)
Type
Description
Partner
Contributing
Partner
Measuremen
t unit
Base
value
Target
value
Period of delivery
output
output
output
output
output
result
result
result
result
4.4. wp5 – Content
Add as many activities (rows) as needed or delete as many activities (rows) if needed
4.4.1.Work Package Main Data
Title
4.4.4. IPA partners activities in the Work package
act 5.2
Description of MN IPA partners activities in the Work
package
Role of each MN IPA partner
Amount
Geographical location
Timeframe
4.4.6. Qualitative and quantitative description of the outputs and results (only outputs and results with
reference to the activities to be carried out by the MN PP)
Type
Description
output
output
output
result
result
result
result
4.5. wp6 – Content
Partner
Contributing
Partner
Measuremen
t unit
Base
value
Target
value
Period of delivery
Add as many activities (rows) as needed or delete as many activities (rows) if needed
4.5.1.Work Package Main Data
Title
4.5.4. IPA partners activities in the Work package
act 6.1
Description of MN IPA partners activities in the Work
package
Role of MN IPA partner
Amount
Geographical location
Timeframe
act 6.2
Description of MN IPA partners activities in the Work
package
Role of each MN IPA partner
Amount
Geographical location
Timeframe
4.5.6. Qualitative and quantitative description of the outputs and results (only outputs and results with
reference to the activities to be carried out by the MN PP)
Type
output
output
output
output
output
output
output
result
result
result
result
result
Description
Partner
Contributin
g Partner
Measurement
unit
Base
valu
e
Targe
t
value
Period of delivery