Application Form 1 - IDENTIFICATION Bilateral Initiative Name * Please, insert the Short Name of the Bilateral Initiative Name Implementation Period From: * Implementation Period To: * Total Amount of the Bilateral Initiative * Requested Amount * Applicant Entity * Tax ID Number * Address * Nature of Entity * Please, select from the dropdown list Government Regional Authority Local Authority Public-Private organization (public sector) Public-Private organization (private sector) Other Public organization Inter-governmental organization Non-governmental organization Social partner Other non-profit organization Large enterprise Small and medium sized enterprise Micro enterprise Phone of the Entity * E-mail of the Entity * Name of legal representative * Function in the Entity * Bilateral Initiative Manager * Function in the Entity * Phone of the Manager * E-mail of the Manager * Consentment * I AUTHORIZE the National Focal Point to collect and process the personal data refered in the application exclusively for this selection process. I AUTHORIZE that the indicated e-mails is used as the address for receiving communications from the National Focal Point regarding the application selection procedure. I AUTHORIZE that the indicated e-mails are part of the National Focal Point database for the purposes of dissimination of information on the EEA GRANTS. 2 - DESCRIPTION AND JUSTIFICATION a) Outline a summary of the Bilateral initiative, identifying its objectives, the innovative approach proposed and the expected bilateral results * b) Explain how the proposed results represent new solutions or new approaches, how can these results be relevant to the respective area of intervention and its potential for dissemination or scaling up of the proposed results * c) Geographical impact * d) Outline the planned activities to achieve the objectives referred to in a) above * e) Describe the main achievements towards the two EEA Grants objectives * f) Identify the target group or the final beneficiaries * g) Outline the means and resources required to achieve the objectives set out in a) above * h) Outline how the ongoing evaluation of the bilateral initiative will be ensured, identifying the associated risks and how they will be mitigated * 3 - PARTNERS INVOLVED Entity Country/City Nature of Entity Please, select from the dropdown list Government Regional Authority Local Authority Public-Private organization (public sector) Public-Private organization (private sector) Other Public organization Inter-governmental organization Non-governmental organization Social partner Other non-profit organization Large enterprise Small and medium sized enterprise Micro enterprise Entity Country/City Nature of Entity Please, select from the dropdown list Government Regional Authority Local Authority Public-Private organization (public sector) Public-Private organization (private sector) Other Public organization Inter-governmental organization Non-governmental organization Social partner Other non-profit organization Large enterprise Small and medium sized enterprise Micro enterprise Entity Country/City Nature of Entity Please, select from the dropdown list Government Regional Authority Local Authority Public-Private organization (public sector) Public-Private organization (private sector) Other Public organization Inter-governmental organization Non-governmental organization Social partner Other non-profit organization Large enterprise Small and medium sized enterprise Micro enterprise Outline a summary of the role of the partners in the implementation of the bilateral initiative 4 - RESULTS FRAMEWORK AND ACTIVITIES TIMELINE Eligible Activity (identified in point 2) * Expected Results * Indicators * Unit of measurement * Target Values * Year N Please enter the year corresponding to the activity Months Year N Please mark the months of activity Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year N+1 Months Year N+1 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year N+2 Months Year N+2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 5 - COMMUNICATION ACTIVITIES AND COMMUNICATION ACTIONS TIMELINE Activities / Comunication Actions * Media / Channel * Reponsible Entity * Expected Results * Year N Months N Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year N+1 Months N+1 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year N+2 Months N+2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Please indicate if the Promoter has: Website * Yes No Site address Social Networks * Yes No Social Network List Facebook Twitter LinkedIn Instagram Youtube Others Username Twitter Username LinkedIn Username Instagram Username Youtube Username 6 - SUSTAINABILITY PLAN FOR THE ESTABLISHED BILATERAL RELATIONS Describe the sustainability of the bilateral partnership and the possibility of future collaboration * Did the partnership already exist? * Yes No With which partners? Please describe why or how you find the partner(s) for this application (v.g matchmaking event, etc.) 7 - REVENUES The bilateral initiative will generate revenue? * Yes No Identify the total amount of revenue preview during the period of execution of the initiative and justify: 8 - DOCUMENTS REQUIRED Documents required * The documents must be sent to the e-mail bilateralrelations@eeagrants.gov.pt Term of Responsability Statutory documents of the applicant entity Proof of the regularized situation with the Tax Authority Proof of the regularized situation with the Social Security Certificate proving the VAT regime Letters of intent from Donor States Partners Letters of intent from national partners and/or from other beneficiary states (if applicable) Unique or autonomous undertaking declaration (if applicable) Budget and timeline