EUROPEAN COMMISSION
DIRECTORATE-GENERAL JUSTICE
Directorate D: Equality
Unit D.4: Non discrimination policies and Roma coordination
GRANT APPLICATION FORM
Call for proposals JUST/2011/PROG/AG/D4
Support to national activities aiming at the identification of
good practices in combating discrimination and promoting
equality
Action Grants
PROGRESS Programme 2007 - 2013
(European Union Programme for
Employment and Social Solidarity)
NOTICE
All personal data (such as names, addresses, CVs, etc.) mentioned in your application form will be processed in accordance with
Regulation (EC) n° 45/2001 of the European Parliament and of the Council of 18 December 2000 on the protection of individuals with
regard to the processing of personal data by the Community institutions and bodies and on the free movement of such data. Your replies
to the questions in this form are necessary in order to assess your grant application and they will be processed solely for that purpose by
the department responsible for the Union grant programme concerned. On request, you may be sent personal data to correct or complete
it. For any questions relating to this data, please contact the Commission department to which the form must be returned. Beneficiaries
may lodge a complaint against the processing of their personal data with the European Data Protection Supervisor at any time (Official
Journal L 8, 12.1.2001).
Please read and complete this form with due care, in accordance with the call for proposals (and its annexes).
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JUST/2011/PROG/AG/D4 / 4000001909
0. GENERAL INFORMATION
Reference Call For
JUST/2011/PROG/AG/D4
National activities antidiscrimination
Application
JUST/2011/PROG/AG/D4
/ 4000001909
Number :
1. INFORMATION CONCERNING THE APPLICANT
1.1 Identity of the applicant organisation
1.1.1 Full legal name (in original
INSTITUT FOR MENNESKERETTIGHEDER
1.1.2 Short name:
DANISH INSTITUTE FOR HUMAN RIGHTS
1.1.3 Organisation's name in English:
DANISH INSTITUTE FOR HUMAN RIGHTS
1.1.4 Organisation's
xxx@xxxxxxxxxxx.xx
1.2 Authorised signatory legally representing the organisation
1.2.1 Full Name*:
JONAS CHRISTOFFERSEN
1.2.2 Position*:
DIRECTOR
1.3 Contact Person
1.3.1 Title:
Ms
1.3.2 Name:
HEMPLER BALLE
1.3.3 First Name:
ANNE-SOFIE
1.3.4 Gender:
FEMALE
1.3.5 Position:
DEPARTMETN COORDINATOR
1.3.6 Direct telephone +countrycode (areacode)
+45 32698888
1.3.7 Direct fax+countrycode (areacode) number:
+45 32698800
1.3.8 Email:
xxx@xxxxxxxxxxx.xx
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1.3.9
STRANDGADE
1.3.10
1.3.11 House
56
1.3.12 Building:
1.3.13 Room Number:
1.3.14 Floor:
1.3.15 PO
1.3.16 Postal
1401
1.3.17 Town/
COPENHAGEN K
1.3.18
DK
1.4 Grants (including operating grants) or contracts obtained in the three previous
years by the applicant organisation (as
applicant or partner) from European Union institutions during the last three years
Service responsible and
Year of
Amount of the
programme
Agreement n°
the
Title of the action
grant
award
(in EUR)
European Commission,
Diversity in the Workplace - Diversity Lab
VP/2008/005/183
2008
265.474
Employment, Social Affairs
and the MIA Award
EU, The Fundamental
Rights and
JLS/2008/FRAC/AG1241
2008
Discrimination Free Schools
389894
Citizen Programme
EU, The Fundamental
Tracing and tackling hate crimes against
Rights and
JLS/2008/FRAC/AG/1226
2008
498915
LGBT persons
Citizen Programme
European Commission,
EU Poster Competition, Rights of the Child
2008
10 400
Directorate-General, Justice
in EU
European Commission,
DIVERSITY LAB - FOR SMES - AND MIA
VP/2009/0390
2009
217 263,89
Employment, Social Affairs
AWARD COMPETITION
European Commission,
JUST/2009/FRAC/
2010
Fight against Homophobia in Schools
1.244.775,16
Directorate-General, Justice AG/1279
EU, The Fundamental
Rights and
JLS/2009/D4/018
2010
Children of Imprisoned Parents
606 896
Citizen Programme
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1.5 Has your organisation requested/obtained an operating grant (subsidy for running costs) which is currently ongoing?
YES
NO
1.6. If yes, please indicate the Union institution and service responsible, the amount and the period covered by the operating
grant:
1.7 Grant applications submitted (or due to be submitted) by the applicant organisation to European Union institutions in
the current year
Service responsible and
Year of
Amount of the
programme
Agreement n°
the
Title of the action
grant
award
(in EUR)
European Instrument for
Reference:
Enhancing respect for human rights and
Democracy and Human
EuropeAid/126352/C/
352.500
fundamental freedoms in count..
Rights
ACT/Multi
European Commission
COLLABORATIVE
Migrant Associations as Mediators of
CORDIS Seventh
PROJECTS FP7-
262.002
Integration in Europe: A Comparat
Framework Progr
SSH-2011-2
2. PARTNERSHIPS
Does your application involve partners?
YES
NO
If your application does not involve any partners (application for a mono-beneficiary grant agreement) you do not need to
fill-in the following questions.
If your application involves partners, please reply to the following questions:
2.1 List of partners involved in the application (maximum 2 partners for each application). The name of the applicant
organisation should not be included.
Legal name of the organisation
Name of the legal representative
Country
1
2
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3. INFORMATION ABOUT THE ACTIVITIES FOR WHICH THE FINANCIAL ASSISTANCE IS REQUIRED
3.1 General information
3.1.1 Title of the action*:
MIA Award 2012 and Equality Lab II
3.1.2 Acronym/Short title*:
MIA Award 2012 and Equality Lab II
(the title is limited to 40 characters, therefore please abbreviate accordingly)
3.1.3 Duration* (Maximum 12 months)
months
12
3.1.4 Planned start date of the activities*
DD/MM/YYYY
(not later than 20/12/2011)
20/12/2011
3.1.5 End date of the activities
DD/MM/YYYY
20/12/2012
3.2 Summary of the activities* (EN/FR/DE) maximum 400 characters)
The over all aim of the project is to mainstream equal opportunities and equal treatment regardless of gender, race, age,
disability, sexual orientation, religion, or an intersection of these grounds in organisations as workplaces as well as in relation
to goods and services, to raise awareness of the anti-discrimination legislation in Denmark and to influence decision makers.
Read more in 3.
Please describe: objectives, activities, number and type of beneficiaries, expected results, output and deliverables. See guidelines of the call
for proposals. Please note that if you have to print the form (see relevant Practicle guide to apply in Priamos and to submit the budget) it is
only printed what is visible on the screen.
Therefore – while a maximum of characters is allowed to type in – be careful with carriage returns and white spaces, in order to fit the
summary also visibly on the page.
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4. BUDGET INFORMATION OF THE ACTION
Important!
The amounts in this section must be identical to the final budget (Excel) which you will submit with this application form
4.1 Project Budget Information
A. Staff
185.573,92
Euro
B. Travel
4.569,17
Euro
C. Equipment
0
Euro
D. Consumables
55.538,63
Euro
E. Other direct costs
Euro
46.370,95
4.1.1 Total direct costs (A+B+C+D+E)*:
292.052,67
Euro
F. Overheads*
20.445,3
Euro
4.1.2 Total eligible costs:
312.497,97
Euro
4.1.3 Project Income / Financial Contributions
4.1.3.1 Financial contribution from the applicant and the partners*:
Euro
62.499
4.1.3.2 Other contribution from third parties*:
Euro
0
4.1.4 EC contribution requested (maximum 80%):
80.00019008123
%
4.1.5 EC contribution requested:
249.998,97
Euro
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5. DECLARATION BY THE APPLICANT
The applicant, represented by the undersigned, being the authorised signatory of the applicant, hereby request from the
Commission a grant with a view to implementing the action on the terms laid down in this application.
I certify that the information contained in this application is correct and that the applicant organisation has not received
or applied for any other Union funding to carry out the action which is the subject of this grant application.
I declare on my honour that the applicant organisation has access to stable and adequate funding to maintain activities
for the period of the project to help finance it as necessary.
I declare on my honour that the applicant organisation has the operational capacity and the operational resources
(technical, management) to successfully complete the activity.
I certify on my honour that the applicant organisation is not in one of the situations which would exclude it from taking
part in a Union grant programme and accordingly declare that the organisation:
-
is not bankrupt or being wound up, is not having its affairs administered by the courts, has not entered into
an arrangement with creditors or suspended business activities, and is not in any analogous situation arising
from a similar procedure provided for in national legislation or regulations;
-
has not been convicted of an offence concerning its professional conduct by a judgment which has the force
of
res judicata;
-
is not guilty of grave professional misconduct proven by any means which the contracting authority can
justify;
-
has met its obligations relating to the payment of social security contributions or taxes under the legislation
of the country in which it is established;
-
has not 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;
-
is not currently subject to an administrative penalty for having been found guilty of serious
misrepresentation in supplying the information required by the Authorizing Officer or for failing to supply such
information, or for having been declared to be in serious breach of contract for failure to comply with its
contractual obligations subsequent to another procurement procedure or grant award procedure financed by
the Union budget;
-
is not subject to any conflict of interest;
-
is not guilty of misrepresentation in supplying any information required by the Authorizing Officer or of
failing to supply this information.
I have been informed that, under Council Regulation (EC, Euratom) N° 1605/2002 of 25 June 2002 on the Financial
Regulation applicable to the general budget of the European Communities OJ L 248, 16.09.2002, p.1, as last amended by
Council Regulation n°1525/2007 of 17 December 2007, OJ L 343, 27.12.2007, p.9, applicants found guilty of false
declarations may be subject to administrative and financial penalties in accordance with the conditions laid down in
that Regulation.
The administrative penalties consist in being excluded from all contracts or grants financed from the Union budget for a
maximum of two years from the date on which the infringement is established, as confirmed after an adversarial
procedure with the applicant. This period may be extended to three years in the event of a repeat offence within five
years of the first infringement. Applicants who are guilty of making false declarations will also receive financial penalties
representing 2% to 10% of the value of the grant being awarded. This rate may be increased to 4% to 20% in the event of
a repeat offence within five years of the first infringement.
Authorized Signatory of the applicant organisation
Title (Mr, Mrs, Prof, etc.)
Mr
Name and Surname
JONAS CHRISTOFFERSEN
Position in the applicant organisation
DIRECTOR
DD/MM/
Date*: 14/06/2011
YYYY
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