To Be Filled In By The Executive Agency

To be filled in by the Executive Agency

Application reference number Postmark / Date of receipt

'Youth in Action' Programme Action 4.4 Youth support systems: Projects encouraging creativity and innovation in the youth sector Call for Proposals EACEA/12/09

APPLICATION FORM

CLOSING DATE FOR SUBMISSION: 30.09.2009 (as per postmark or the date of the deposit slip in case of dispatch by express courier) Applications bearing a postmark after this date will not be considered. Applications must be sent by post bearing the original signature of the legal representative of the applicant organisation and the original signatures of the partners. Handwritten applications and/or sent by fax or e-mail will not be accepted.

Please fill in all relevant sections of this application. It is compulsory to annex ALL documents requested in the check list. Please consult the Call for proposals EACEA/12/09 to find all the information you need to lead your project and to fill in this application form.

Part I. Identification of the applicant organisation A. Details of the applicant organisation1 Full name

Acronym:

Registered address

Street:

N°:

Postcode

City

Region

Country

Telephone

Fax

Website Person authorised to represent the organisation in legally binding agreements (legal representative) Surname (Ms/Mr)

First name

Position/function

Email

Person in charge of the project (contact person) Surname (Ms/Mr)

First name

Position/function

Email

Telephone

Fax

B. Profile of the applicant2 Legal status

Private

Public

Type

Non-profit

NGO

Activity level

Local

Regional

National Youth Council National

European/International

Please give a short presentation of your organisation (aims and regular activities, membership in other structures, specific expertise, staff, possible involvement of young people under 30 in the organisation's structure and activities, etc.) and explain your motivation to carryout the proposed project.

1

Please download and fill in the legal entity identification form from the European Commission’s website: http://ec.europa.eu/budget/execution/legal_entities_en.htm

2

Please join relevant "Articles of association" (statutes): document that sets out the structure, purpose and operating parameters of your organisation

'Youth in Action' Programme – 2009_Action 4.4: Creativity & Innovation – APPLICATION FORM

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C. Operational capacity Professional competences and qualifications: • Please describe the know-how of your organisation in the fields covered by the Call for proposals (see point 2.2 of the Applicants' Guidelines). Such experience is to be illustrated by means of a list of projects already implemented (the past two years only) in the relevant fields. • Please also mention the different products realised by these projects, i.e. publications, website, etc. Please give precise references. • Please attach a copy of the Curriculum Vitae of the person responsible for the general coordination/implementation of the action (contact person).

D. European Community funding obtained the last two financial years Applica nt

Partner

Agreement n°

Programme/Ac tion

Amount in €

Project title

E. Has your organisation submitted, or does it intend to submit, a grant application for this project or any other project to other Actions of the 'Youth in Action' Programme or to (an)other European Community Programme(s) in 2009? NO

YES

Application submitt ed

(please specify)

Project

intend to submit

the same

an other

'Youth in Action' Programme (please specify Action)

Other EC Programme (please specify)

Amount in €

'Youth in Action' Programme – 2009_Action 4.4: Creativity & Innovation – APPLICATION FORM

Grant decision taken Not Yes yet

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F. Declaration on honour ►

To be signed by the person authorised to enter into legally binding commitments on behalf of the applicant

I, the undersigned, certify that all information contained in this application, including project description, is correct to the best of my knowledge and am aware of the content of the annexes to the application form. I confirm that my organisation/group has the financial and operational capacity to complete the proposed project. I confirm that my organisation/group has taken the appropriate measures to ensure the protection and safety of participants involved in the project. I take note that under the provisions of the Financial Regulation applicable to the general budget of the European Communities, grants may not be awarded to applicants who are in any of the following situations: (a) if they are bankrupt or being wound up, are having their affairs administered by the courts, have entered into an arrangement with creditors, have suspended business activities, are the subject of proceedings concerning those matters, or are in any analogous situation arising from a similar procedure provided for in national legislation or regulations; (b) if they have been convicted of an offence concerning their professional conduct by a judgment which has the force of res judicata; (c) if they have been guilty of grave professional misconduct proven by any means which the contracting authority can justify; (d) if they have not fulfilled obligations relating to the payment of social security contributions or the payment of taxes in accordance with the legal provisions of the country in which they are established or with those of the country of the contracting authority or those of the country where the contract is to be performed; (e) if they have been the subject of a judgment which has the force of res judicata for fraud, corruption, involvement in a criminal organisation or any other illegal activity detrimental to the Communities' financial interests; (f)

if following another procurement procedure or grant award procedure financed by the Community budget, they have been declared to be in serious breach of contract for failure to comply with their contractual obligations;

(g) if, on the date of the grant award procedure, they are subject to a conflict of interest; (h) if, on the date of the grant award procedure, they are guilty of misrepresentation in supplying the information required by the contracting authority as a condition of participation in the grant award procedure or fail to supply this information. I confirm that neither I nor the organisation/group for which I am acting as legal representative are in any of the situations described above, and am aware that the penalties set out in the Financial Regulation may be applied in the case of a false declaration. In the event that my grant application is successful, I authorise the Commission/the Agency to publish on its internet site or in any other appropriate medium: •

The name and address of the beneficiary of the grant;

•

The subject of the grant;

•

The amount awarded and the rate of funding of the costs of the approved work programme.

Applicant organisation: Legal representative:

Stamp (if available)

(Mr/Ms Surname, First name)

Position/function in the organisation: Date:

(dd/mm/yyyy)

Signatur e

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Part II. Identification of the partners ►

To be filled in by each partner organisation

A. Details of the partner organisation Full name

Acronym:

Registered address

Street:

N°:

Postcode

City

Region

Country

Telephone

Fax

Website Person authorised to represent the organisation in legally binding agreements (Legal representative) Surname (Ms/Mr)

First name

Position/function

Email

Person in charge of the project (contact person) Surname (Ms/Mr)

First name

Position/function

Email

Telephone

Fax

B. Profile of the partner Legal status

Private

Public

Type

Non-profit

NGO

Activity level

Local

Regional

National Youth Council National

European/International

Please give a short presentation of your organisation (aims and regular activities, membership in other structures, specific expertise, staff, possible involvement of young people under 30 in the organisation's structure and activities, etc.) and describe your competencies and motivation to cooperate in the implementation of the project.

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C. Mandate(s) ►

To be signed by the persons authorised to enter into legally binding commitments on behalf of the applicant, respectively each partner

MANDATE [full official name of the organisation] [official address in full] [ISO-code country – Postal code CITY], (“the partner”), represented for the purposes of signature of this mandate by [surname, first name and function] of the one part, and [full official name of the organisation] [official address in full] [ISO-code country – Postal code CITY], (“the applicant”), represented for the purposes of signature of this mandate by [surname, first name and function] HAVE AGREED for the purposes of the implementation of the action entitled [project title] ("the action"); the following:

1. The partner grants power of attorney to the applicant, to act in its name and for its account in submitting the above project and, if selected for a grant award, signing an agreement and its possible subsequent riders with the Education, Audiovisual and Culture Executive Agency. Accordingly, the partner hereby mandates the applicant to take full legal responsibility for the implementation of the above project and related agreement with the Agency.

2. The partner hereby confirms having taken careful note of all the provisions of the relevant call for proposals and model grant agreement, in particular of all provisions affecting the partner and the applicant (Article I.3). The partner acknowledges that, by virtue of this mandate, the applicant alone is entitled to receive the funds from the Agency and distribute the amounts corresponding to the participation of each organisation in the project as laid down in Article I.3.1h and Article I.7.3 of the proposed agreement.

3. The partner hereby agrees to do everything in his power to carry out properly the actions assigned to him acting on his own responsibility, and certifies that it has the operational and financial capacity to participate in the action mentioned above.

4. The partner hereby agrees to do everything in his power to help the applicant fulfil its obligations under the proposed grant agreement. In particular, the partner hereby agrees to provide to the applicant whatever documents or information may be required under the terms and conditions of the grant agreement, as soon as possible after receiving the request from the applicant.

5. The provisions of this mandate, shall take precedence over any other agreement between the partner and the applicant, which may have an effect on the implementation of the agreement between the co-ordinator and the Education, Audiovisual and Culture Executive Agency.

6. Subject to selection for a grant award, a copy of this mandate shall be annexed to the agreement signed between the applicant and the Agency and shall form an integral part of it.

SIGNATURES For the partner

For the applicant

[surname/first name] Function: Done at

, , Date: . . / . . / . . . .

[surname/first name] Function: Done at

, , Date: . . / . . / . . . .

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In triplicate in English

'Youth in Action' Programme – 2009_Action 4.4: Creativity & Innovation – APPLICATION FORM

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Part III. Project identification and summary A. Title of the project Please give a short title to the project.

B. Duration of the project Please indicate the total duration of the project from preparation to evaluation and also the venue(s) where the project activities will be carried out.

Start date of the project: (date of first costs incurred)

date of the project: …. / …. / …… End (date of last costs incurred)

…. / …. / ……

Total duration (in months)

Venue(s):

C. Objectives Please tick the box(es) corresponding to the Objective(s) addressed by the project

(1) Promote young people’s active citizenship in general and their European citizenship in particular (2) Develop solidarity and promote tolerance among young people (3) Foster mutual understanding between young people in different countries (4) Promote European cooperation in the youth sector (5) Contribute to developing the quality of support systems for youth activities and the capabilities of

civil society organisations in the youth sector

D. Priority themes Please tick the box (one only) corresponding to the Theme addressed by the project

(1) Media literacy of young people (2) e-youth work

E. Activities Please tick the box(es) corresponding to the Activity(ies) addressed by the project.

Virtual activities using web tools

Awareness raising campaigns

Seminars

Networking activities

Training courses

Exchange of best practices

Creation and production of innovative audiovisual and multimedia tools

Other (please specify): _____________________________ _____________________________

F. Creativity and Innovation Please tick the box(es) corresponding to the Creative/Innovative element of your project

Content

Conceptual

Methodology

Technological

Other (please specify): _____________________________ _____________________________

'Youth in Action' Programme – 2009_Action 4.4: Creativity & Innovation – APPLICATION FORM

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G. Project partners (including the applicant) and related number of participants

Organisation name

Legal status & Type

Country

Number of young people/youth workers

Number of trainers, facilitators, staff

n° 1 n° 2 n° 3 n° 4 n° 5 n° 6 Total n°:

H. Summary of the project Please, give a brief summary of your project (approximately 2.000 characters). Please note that this section may be used for publication. Therefore be accurate and include: • Creative/Innovative element of your project • Objectives (including priority theme chosen) • Concise description of the outputs (tangible results) • Activities foreseen • Dissemination and exploitation strategy • Venue(s) • Impact envisaged • Number of participants The summary should be written in English, French or German, regardless of which language you use to fill in the rest of this application. Please be concise and clear.

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Part IV. Project implementation 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 monitoring and evaluation of the project.

If more space is needed, please extend boxes

A. Objectives of the project Please describe: • the General Objectives of the Youth in Action Programme targeted by your project;

• •

how the project is targeting the Specific Objective (creative and innovative ability of young people) of this call for proposals;

•

the expected results and the target group(s) of the project.

how you are going to address the Priority Theme (media literacy of young people / e-youth work) you have chosen;

B. Creative/Innovative aspect Please explain in detail: • what are the creative (beyond originality) characteristics of your project;

•

why your project is genuinely innovative.

C. Work programme Please describe: • the working methods envisaged;

•

the activities foreseen throughout the action for its implementation, including preparatory and evaluation activities;

• •

the sharing of tasks within the applicant organisation and among the partners;

• •

how you intend to organise and co-ordinate the activities with regard to the scale of your project; how you intend to ensure the quality and coherence of the project work programme; how the planned activities and working methods will contribute to the process of non-formal learning and to the promotion of social, professional and personal development of young people involved in the project.

Please identify, where relevant, specific tasks that will be sub-contracted to bodies other than the applicant organisation and/or partners.

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C. Work programme (cont.) Please give details for each of the activities foreseen.

Partner organisation(s) involved Activity

from

to

(m/yyyy)

(m/yyyy)

Venue Organisation name

Country

Role in the activity

(ISO code)

Gender N° of N° of young trainers, people/youth n° of n° of facilitators, workers staff F M

n° 1 n° 2 n° 3 n° 4 n° 5 n° 6 n° 7 n° 8 n° 9 n° 10 n° 11 Total n°:

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D. Multiplying effect and sustainable impact of the project Please describe: • the multiplier effect of the project for the development of youth work, youth policies and youth empowerment;

•

the impact that the planned activities will have on the young people involved;

•

the impact in a longer term perspective on youth work, youth policies and/or the capacity-building and leadership development of the youth organisations/structures; the impact of the project on the development of sustainable partnerships and networking among youth organisations.

•

Please also identify indicators which could help you measuring the impact of the project. Please indicate the estimated number of young people indirectly benefiting from the project and explain how this will be achieved.

E. Quality of the partnership Please describe: • the profile of your partners, focusing particularly on their experience in the field of youth;

• •

the reasons why they are chosen as partners, as well as their motivation to participate; the division of tasks among the partnership and the role of each partner in the cooperation.

You should illustrate your response with specific examples of actions. Please also state what kind of complementarity your partnership is based upon. Finally, explain briefly who are the main actors of the project, for each partner, describing their specific skills.

F. Involvement of participants Please explain: • how the participants will be selected;

•

how they will be involved in the project;

Please point up the activities attended to and run by young people. • how will young people be involved in each stage of the project.

•

Does your project involve young people with fewer opportunities?

Yes

No

If so, please tick the situation(s) they face and explain how this will be achieved. Geographical obstacles

Health problems

Economic obstacles

Disability

Educational difficulties

Social obstacles

Cultural differences

Other: _________________

'Youth in Action' Programme – 2009_Action 4.4: Creativity & Innovation – APPLICATION FORM

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G. Dissemination and exploitation of results Please describe: • the tangible results you intent to achieve;

•

the products you plan to develop during the project.

Please give a detailed description of the strategy defined and the measures planned in view to spread and exploit the results of the project.

H. Visibility Apart from the compulsory use of the 'Youth in Action' Programme logo (Point 11 - Publicity of the Applicants' Guidelines), please describe: • how you will ensure the broad visibility of your activities and of the project as a whole;

•

how your project will provide clear promotional added value for the 'Youth in Action' Programme.

I.

Evaluation and follow-up

Please describe: • how you will ensure the evaluation and follow-up of the project. Please provide details of: • the evaluation activities to be performed during the project implementation;

• •

your risk assessment as regards implementation of the project (qualitative and quantitative values) and corrective measures planned; the evaluation activities at the end of the project.

J. Quantitative information on the different actors involved in the project EU27

Other Programme countries

Total

Number of partners involved in the project Number of countries involved in the project Number of youth workers directly involved in the project Number of young people directly involved in the project Number of young people with fewer opportunities involved in the project

'Youth in Action' Programme – 2009_Action 4.4: Creativity & Innovation – APPLICATION FORM

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Part V. ESTIMATED BUDGET For information on funding rules and eligibility of costs please consult the text of the Call for proposals. Please note that the Executive Agency has the right to revise the amounts (including the EC grant requested) on the basis of the rules set out in the Call for proposals

All figures in EURO - €

EXPENDITURE Total (in cash)

Direct costs (1)

Costs directly linked to the implementation of project activities

(2)

Production / Translation / Dissemination / Information costs

(3)

Information and Communication Technology (ICT) costs

(4)

Travel, board and lodging costs

(5)

Personnel costs (up to 30% of other direct eligible costs, i.e. budget chapters 1 + 2 + 3 + 4)

(6)

Indirect costs (up to 7% of all direct eligible costs, i.e. budget chapters 1 + 2 + 3 + 4 + 5)

Sub-total direct costs

A. TOTAL EXPENDITURE (without contributions in kind) B. Contributions in kind3 TOTAL A + B

INCOME Name, description (1)

National/regional/local institutions

(2)

Other Community funding for this project

(3)

Private donors

(4)

Other resources

(5)

Own resources (including partners')

(6)

EC grant requested from the 'Youth in Action' Programme

Total (in cash)

(maximum 65% of A: Expenditure)

A. TOTAL INCOME (without contributions in kind) B. Contributions in kind3 TOTAL A + B Applicant organisation: Legal representative:

Stamp (if available)

(Mr/Ms Surname, First name)

Position in the organisation: Date: (dd/mm/yyyy)

3

Signatur e

Total B should equal the sum of contributions in kind claimed under each budget heading (see 'Detailed calculation of estimated costs' hereafter). Please also note that the same figures should be reported in both estimated expenditure and estimated income sections. Contributions in kind shall not exceed 10% of the project's budget.

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Detailed calculation of estimated costs

►

Please note that each item embedded in the budget must be clearly identified and specified

1. Costs directly linked to the implementation of project activities Where applicable, please separate clearly the different phases of your project (e.g. preparation, activity, follow-up, etc.) in the “specification” column.

a. Insurance and visa costs Costs Organisation

Activity

Specification

in cash (a)

in kind (b)

Total (a+b)

Sub-total (a) b. Rental of rooms for meetings, conferences, other events, etc. Costs Organisation

Activity

Specification

in cash (a)

in kind (b)

Total (a+b)

Sub-total (b) c. Interpretation costs (including travel, accommodation and fees) Languages Activity from

into

Nr of interpreters

Nr of days

Amount per day

Costs in cash (a)

in kind (b)

Total (a+b)

Sub-total (c)

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d. Hire of booths for interpretation (including equipment) Activity

Nr of days

Specification

Amount per day

Costs in cash (a)

in kind (b)

Total (a+b)

Sub-total (d) e. Fees for external speakers Nr of speakers

Activity

Nr of days

Amount per day

Costs in cash (a)

in kind (b)

Total (a+b)

Sub-total (e) f. Other Please specify other possible costs. Costs Organisation

Activity

Specification

in cash (a)

in kind (b)

Total (a+b)

Sub-total (f) TOTAL COSTS DIRECTLY LINKED TO THE IMPLEMENTATION OF PROJECT ACTIVITIES

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2. Production / Translation / Dissemination / Information costs Please indicate costs of production and distribution of information, of documents and materials to be published (CD-ROM, video, books, leaflets, etc.) including the estimated number of copies needed.

a. Production Nr of copies

Specification

Costs Unit price

in cash (a)

in kind (b)

Total (a+b)

Sub-total (a) b. Translation Languages Specification from

into

Nr of pages

Price per page

Costs in cash (a)

in kind (b)

Total (a+b)

Sub-total (b) c. Dissemination / Information costs Costs Specification

Nr of items

Unit price

in cash (a)

in kind (b)

Total (a+b)

Sub-total (c) TOTAL PRODUCTION / TRANSLATION / DISSEMINATION / INFORMATION COSTS

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3. Information and Communication Technology (ICT) costs Computer and audiovisual equipment purchased or rented during the project lifetime The depreciation rule applies to any purchase above EUR 500

Activity

Specification

Degree of Depreciation use in the rate project (%)

Cost (purchase value)

Costs in cash (a)

in kind (b)

Total (a+b)

TOTAL ICT COSTS

4. Travel, board and lodging costs a. Travel costs Please note that only cheapest means of transport and fares are subject to reimbursement (APEX airfare, 2nd class train ticket, etc.). In case of travel by private car a flat reimbursement of EUR 0,22 €/km applies. The number of persons consists of the total of young people/youth workers, trainers and support staff participating in each activity. Activity

Organisation

Nr of persons

Origin

Destination

Means of transport

Costs in cash (a)

in kind (b)

Total (a+b)

Sub-total (a) b. Board and lodging costs (including local transport) Please keep in mind that subsistence (accommodation and daily allowance) costs should be in line with the usual practice of your organisation and where applicable of your partners. If these costs are considered to be extravagant, they will be reviewed and capped at the scales annually approved by the European Commission (see table of DAILY SUBSISTENCE ALLOWANCES). The number of persons consists of the total of young people/youth workers, trainers and support staff participating in each activity. Costs Average (Total nr of days * Average cost per day) Nr of Total nr Activity Organisation Place of stay cost per persons of days in cash in kind Total day (a) (b) (a+b)

Sub-total (b) TOTAL TRAVEL, BOARD AND LODGING COSTS

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5. Personnel costs

[up to 30% of other direct eligible costs (in cash), i.e. budget chapters 1 + 2 + 3 + 4]

Please indicate the personnel costs directly linked to the activity (including names, functions and whether the person is directly recruited for this project). Separate clearly internal staff of your organisation or partners from recruited personnel. Name

Function

Nr of Internal or days or recruited months

Gross salary per day or month

Costs in cash (a)

in kind (b)

Total (a+b)

TOTAL PERSONNEL COSTS

6. Indirect costs

[up to 7% of all direct eligible costs (in cash), i.e. budget chapters 1 + 2 + 3 + 4 + 5]

This budget chapter takes account of the general costs incurred in connection with the implementation of the project (e.g., office supplies, consumables, telecommunication, rent, electricity, heating, maintenance, depreciation of office equipment)

TOTAL INDIRECT COSTS

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Part VI. BANK DETAILS Please download and fill in the financial identification form for your country from the following WEB-site: http://ec.europa.eu/budget/execution/ftiers_en.htm

CECK LIST ► ►

Before submitting this application form to the Executive Agency, please check the following:

The proposal – submitted in one original only – must comprise the following documents: an official letter of motivation, dated and signed by the person authorised to enter into legally binding commitments on behalf of the applicant organisation the application form, duly completed and signed in original by the person authorised to enter into legally binding commitments on behalf of the applicant (signatures required in Parts: I.F, II.C and V of the form) the declaration on honour (Part I.F of the application form), duly completed and signed by the person authorised to enter into legally binding commitments on behalf of the applicant organisation, attesting to its status as a legal person and stating that it has the operational and financial capacity to complete the proposed activities, and certifying that none of the situations mentioned in Articles 93(1), 94 and 96(2)(a) of the Financial Regulation apply the mandates (Part II.C of the application form), duly completed and signed by the applicant and the partners the estimated budget (Part V of the application form), duly completed (detailed calculation of estimated costs included) and signed by the person authorised to enter into legally binding commitments on behalf of the applicant organisation

►

The application must also include the following documents: the legal entity identification form duly signed by the person authorised to enter into legally binding commitments on behalf of the applicant organisation. Please note that complementary justification documents are required according to the applicant’s status, as specified in each type of form, i.e. private/public entity. (This form can be downloaded from the European Commission’s website: http://ec.europa.eu/budget/execution/legal_entities_en.htm) the financial identification form duly signed by the person authorised to enter into legally binding commitments on behalf of the applicant and certified by the bank (original signatures required). Please fill in the form relating to the country in which the bank is located, even in case the applicant organisation is officially registered in another country. (This form can be downloaded from the European Commission’s website: http://ec.europa.eu/budget/execution/ftiers_en.htm) the Articles of association (statutes), part I.B of the application form a copy of the Curriculum Vitae (part I.C of the application form) of the person responsible for the general coordination/implementation of the action (contact person)

►

Additional mandatory documents for grant requests exceeding € 25 000: In accordance with the provisions of the Financial Regulation applicable to the general budget of the European Communities, all applicant promoters – with the exception of public bodies – to EU funding exceeding € 25 000 must submit, together with their application form, the following financial documents: the balance sheet for the last financial year for which the accounts have been closed and the profit and loss accounts of the applicant organisation the financial capacity form concerning the last financial year for which the accounts have been closed in accordance with the form available at the website of EACEA: http://eacea.ec.europa.eu/youth/funding/2009/call_action_4_4_en.php

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