APPLICATION FORM FOR
FUND FOR LOCAL COOPERATION 
FOR THE REPUBLIC OF MOLDOVA IN 2019

Date:

Submitted by:

Telephone:

E-mail:

Full mailing address:

A.	Summary (max 2  pages)

1.	Name of the organisation:

2.	Project/Program title:

3.	Total budget in EUR:
Requested from the Embassy of Finland: 

Organisation’s contribution to the project budget 
In kind:
In cash:	

4.	Duration:
Months:	Start date: (dd/mm/yyyy)	End date: (dd/mm/yyyy)	
		         	
5.	Overall objective and specific objectives of the project:

	

6.	Partner(s):

7.	Target group(s):

8.	Main activities related to each result:

9.	If you have submitted this proposal to another donor agency, please specify the name of the donor organisation and date of submission. Please inform the Embassy of Finland immediately in case you receive a positive funding decision from another donor.

	
A.	
B.	Contact information on the organisation

Organisation’s information

1.	Name of the organisation and abbreviation:

2.	Official status of the organisation (including the registration number and date): 

3.	Street address and town:

4.	Telephone number:

5.	E-mail address:

6.	Web address:

7.	Bank account details:

Organisation leader/director

1.	Director (person in charge):

2.	Telephone number:

3.	E-mail address:

     Description of the organisation

1.	Please provide a brief description of your organisation:

2.	Number of members: 

3.	Number of full-time employees:

4.	Financing  sources of the organisation: 

C.	Detailed information on the proposed project

1.	Reason(s) for launching the project/project justification:

2.	Previous experience of the organisation in the same sector and same theme of work:

3.	Existing financing from other agencies:

4.	Project overall objective and specific objective(s):

5.	Project expected results: 

6.	Description of the activities: 

7.	Timetable for the planned activities:

8.	Description of the approach: how the project intends to create changes, what methods 
 would be utilised, how different social groups and interests would be taken into consideration: 

9.	The target group. The relation of the organisation with the target group:

10.	Exit strategy. How do you plan to ensure sustainability of the project beyond the grant period: 

11.	How will  the project address/take into account  the cross cutting objectives of Finland’s Development Policy:

•	Gender equality
•	Non-discrimination 

12.	Commitment to the Human Rights Based Approach (HRBA) supports more sustainable development results and clarifies accountability for development. Explain in details how will this project:

a) Enhance rights-holders’ (local people and all those affected by our development policy actions) awareness of the human and fundamental rights that they are entitled to and improve their capacity to defend these rights; 
b) Increase duty-bearers’ (local authorities) knowledge of their own responsibilities and improve their capacity to implement the requirements.

13.	Other development actors in the same field of work and your plans of coordinating. How will your plans complement other efforts:

14.	How does the proposal take into account development plans and strategies of the Republic of Moldova. Explain if there are plans for engaging any governmental bodies. (Thorough analysis of this issue will be seen as advantage but this question can also be disregarded if it is not applicable for the context of your proposal or you have explained this already in other parts of the proposal.)

15.	Summarize major risks in relation to achieving the results of project objectives and explain the mitigating measures:

16.	Monitoring arrangements and evaluation:

17.	Reporting schedule:

18.	Audit arrangements:

19.	Visibility: 

20.	Additional information of relevance for the application:

D.	Possible cooperation partner

1.	Name and type of organisation:
2.	Street address and town:
3.	E-mail address:
4.	Web address:
5.	Contact person:
6.	Applicant’s previous experience with this partner:
7.	Describe partner organisation’s technical competence/knowledge in relation to the project:
8.	Please describe the partner’s tasks and responsibilities in implementing the project:

Annex 1: Budget (obligatory). Proposed budget shall clearly present all the sources of funds allocated to the project including organisation’s own contribution in cash or in kind. You may also provide a narrative to explain the budget in detail. Please use the template below.
	
Annex 2: Result Framework. The Result Framework Model (Annex 2) includes a fictive project proposal as an example on how to fill in the table. Please, take a look to the way table is filled and use the empty Result Framework table (Annex 2A or 2B depending on the thematic area of the proposal) to fill in your project proposal accordingly. Delete the Result Framework Model from the final project application.

Annex 2A: Result Framework for projects promoting Human Rights of people with disabilities or Annex 2B: Result Framework for a project proposal promoting freedom of expression and media diversity (obligatory to fill in either Annex 2A or 2B). Please use one of the template below depending project proposal’s thematic area. In the Results Framework of an FLC project, the outcome and impact are derived from the FLC Programme, for the project's outputs are expected to contribute to the FLC Programme's outcome in the sector / theme in question, which then in turn contributes to the impact of the Programme. A complete Results Framework will include indicators, baseline data, risks and risk management.

Annex 3: The CV of the Project Manager and other key staff. You can use the template below or other similar forms. One CV should not extend two pages. If you use other templates, please delete the one below.

E.	 Certification

By signing this application, I certify that the statements contained in this form are true, complete and accurate.
I am aware that any false statements or claims may disqualify my organisation from receiving this and any future grants.

PLACE/DATE					SIGNATURE

----------------------------------------			----------------------------------------

Annex 1: Budget Form

	Activity Description	Unit	Quantity	Unit Cost	Total	FLC/
Embassy of Finland	Organisation	Percentage
%	
I.	Expected Result 1								
I.1	Activity 1								
I.1.1	Activity 1.1								
I.1.2	Activity 1.2								
I.2	Activity 2								
I.2.1	Activity 2.1								
…	add rows if need be								
II.	Expected Result 2								
II.1	Activity 1								
II.1.1	Activity 1.1								
II.1.2	Activity 1.2								
II.2	Activity 2								
II.2.1	Activity 2.1								
…	add rows if need be								
III.	Personnel engaged in activities 								
III.1									
III.2									
…	add rows if need be								
IV.	Administration costs*								
	(phone, office supplies, financial management)								
	(audit)								
V.	Other costs 								
									
TOTAL								

Annex 2: Result Framework (Model)
Result Framework of a fictive FLC-project. This model provides an example on how to fill in Result Framework (Annex 2A or Annex 2B).
Remove this page from the final application.  
Implementation	Results	
INPUTS	ACTIVITIES	OUTPUTS	OUTCOME	IMPACT	
Funding and other support by the Mission	Main activities of the project	Expected main output of the project	Thematic outcome of the FLC Programme to which the project's output is expected to contribute (a short and medium term effect of  the project)	Overall objective / Impact of the FLC Programme
(long-term effects produced by the FLC Programme)	

EXAMPLE
A project on voter and civic education in the targeted provinces XX	
Voter and civic education
-  For example, the FLC partner organization organizes training and dissemination of information to inform voters and civil society actors about civic rights and  elections.	
For example, citizens and civil society actors have been informed of civic rights and electoral processes.

Indicators, for example:
•	Number of the people reached, including the share of women and vulnerable groups.
•	Number of the workshops held.
•	Amount of the materials disseminated.
•	Number of the civil society actors involved.

Baseline data, for example:
•	Data in the needs assessment / baseline study of the project.

Risks, for example:
•	Many marginalized communities are not reached by the project.
•	Low interest of people and civil society actors in elections and politics.
•	Low interest of people in women's and vulnerable groups' rights.	
Improved understanding of citizens and civil society actors, particularly women and vulnerable groups, about civic rights and electoral system.

Indicators:
•	General turnout in elections and the share of women and vulnerable groups among voters, candidates and elected decision-makers.

Baseline data (when the current FLC Programme started):
•	Data in the needs assessment / baseline study of the sector / theme A of the FLC Programme.
•	Statistical data on the elections.

Risks:
•	Limited interest and resources of civil society actors to participate in elections and politics.
•	Duty-bearers' and rightsholders' low interest in women's and vulnerable groups' rights, 
•	Political unrest or conflicts halt democracy and HR processes.
	
Enhanced capacity of civil society actors to promote democracy, equality and Human Rights.

Indicators:
•	Participation of women's and other NGOs in democracy and HR dialogue processes.
•	Position of the country in the Global Democracy Ranking.

Baseline data (when the current FLC Programme started):
•	Data in EU reports on the participation of civil society actors in democracy and HR dialogues.
•	Democracy Ranking index.

Risks:
•	Restrictions by authorities on civil society.
•	Limited financial resources of civil society actors.
•	Sudden changes in the Mission's strategy and action plans.	

	

Implementation	Results	
Annex 2A: Result Framework for a project proposal promoting Human rights of people with disabilities 
	   Fill in the points marked in italics. You can add as many indicators, baseline data and risks as you wish. The text written in bold shall not be removed 
 	   or replaced as it indicates the outcome and impact of the FLC programme as well as indicators, baseline data and risks.
		
INPUTS	ACTIVITIES	OUTPUTS	OUTCOME	IMPACT	
Funding and other support by the Mission	Main activities of the project	Expected main output of the project	Thematic outcome of the FLC Programme to which the project's output is expected to contribute (a short and medium term effect of  the project)	Overall objective / Impact of the FLC Programme
(long-term effects produced by the FLC Programme)	

A project on Support to strengthening the capacity of individuals and authorities to promote human rights of people with disabilities
Project title
	
Activity 1
Activity 2
Activity 3 
…
	
Main output of the project

Indicators
Indicator 1 
Indicator 2
….

Baseline data
Baseline 1
Baseline 2
…

Risks
Risk 1 

Risk 2 

…	
Strengthened capacity of individuals and authorities to promote the Human Rights of people with disabilities in Moldova. 

Indicators
Indicator 1
Indicator 2 
…

Baseline data (when the current FLC Programme started):
•	Moldovan NGOs working in the field of social and health affairs and education. 
•	Other baseline data

Risks
•	Limited resources of civil society organisations – dependency on foreign donors. 
•	Authorities lack resources and prioritize other areas than the rights of people with disabilities and principle of non-discrimination.
•	More risks	
Increasing the possibility of people with disabilities to participate equally in public life and decision-making. Support possibility of people with disabilities to enjoy these rights and freedoms without discrimination. 
Enhanced capacity of civil society actors to promote democracy, equality, non-discrimination, gender equality and Human Rights.

Indicators
•	Structures and policies support full citizenship for people with disabilities.
•	People with disabilities participate in public life and decision making with equal rights.
•	More indicators

Baseline data (when the current FLC Programme started):
•	Freedom House index 2019, Moldova gets 58/100 points, partially free (2018, 61/100). 
•	Other baseline data

Risks
•	Restrictions by authorities on civil society activities.
•	Limited financial resources of civil society actors.
•	Sudden changes in the Mission's strategy and action plans.
•	more risks 	

Annex 2B: Result Framework for a project proposal promoting freedom of expression and media diversity
Fill in the points marked in italics. You can add as many indicators, baseline data and risks as you wish. The text written in bold shall not be removed 
 	   or replaced as it indicates the outcome and impact of the FLC programme as well as indicators, baseline data and risks.
		
INPUTS	ACTIVITIES	OUTPUTS	OUTCOME	IMPACT	
Funding and other support by the Mission	Main activities of the project	Expected main output of the project	Thematic outcome of the FLC Programme to which the project's output is expected to contribute (a short and medium term effect of  the project)	Overall objective / Impact of the FLC Programme
(long-term effects produced by the FLC Programme)	

A project on support to the freedom of expression and media diversity
Project title	
Activity 1
Activity 2
Activity 3 
…
	
Main output of the project

Indicators
Indicator 1 
Indicator 2
….

Baseline data
Baseline 1
Baseline 2
…

Risks
Risk 1 

Risk 2 

…

Strengthening freedom of expression and media diversity supported in Moldova. Support limiting distribution of false information and hate speech in media. Investigative journalism and media literacy promoted in Moldova. 

Indicators:
Indicator 1
Indicator 2
…

Baseline data (when the current FLC Programme started):
•	Reporters without borders freedom of press index. Position 81 (2018). The ranking of Moldova has worsened in 5 years by 26 positions (55, 2013) 
•	other baseline data

Risks
•	Limited resources of media stakeholders working in the field of freedom of expression and media diversity – dependency on foreign donors
•	Harassment of independent media and civil society organisations working in the field of freedom of expression and media diversity
•	Authorities’ low interest in securing the freedom of expression for everyone  
•	More risks

	
Strengthened capacities of media stakeholders in Moldova. 
Enhanced capacity of civil society actors to promote democracy, equality, freedom of media, non-discrimination, transparency and Human Rights.

Indicators
•	Diversity of media information and marketing in Moldova
•	Harassment free investigative journalism 
•	Other indicators

Baseline data (when the current FLC Programme started):
•	The Economist Democracy Ranking index Moldova takes position 79/167, hybrid regime (2018). In 2016, Moldova’s position is 76/167 flawed democracy. 
•	Freedom House index 2019, Moldova gets 58/100 points, partially free (2018, 61/100). 
•	Other base line data

Risks
•	Restrictions by authorities on civil society and media
•	Limited financial resources of civil society actors.
•	Sudden changes in the Mission's strategy and action plans.
•	More risks	

Annex 3: CV(s)

Name SURNAME

Contact Details
Postal address  ∙  phone  ∙   email address

CAREER HISTORY (MAX. 3 MOST RELEVANT JOBS)

JOB TITLE 
Employers name    -   Employment dates
Write a brief paragraph, describing the organisation or company. Explain your role and duties within the organisation.

JOB TITLE 2
Employers name    -   Employment dates
Write a brief paragraph, describing the organisation or company. Explain your role and duties within the organisation.

ACADEMIC QUALIFICATIONS

University/Educational institution name
Here enter the degree you took.  
Here enter the location & date. 

Add items if need be.

LANGUAGE SKILLS AND OTHER KEY SKILLS AND COMPETENCIES
Here write a brief introduction your relevant skills.