The applicant should ensure that all of the information required below is accurately entered

    1. Request submitted by:
    Name of country:
    Name of NGO in official partnership with UNESCO (full name and acronym):

    2. Title of project and place of implementation:
    Title of project:
    Place of implementation:
    Commencement date:
    Termination date:
    Priority number for Member States (from 1 to 7):
    Please take account of the fact that the first approvals will not be granted before
    May 2018 for Africa, LDCs and SIDS, and October 2018 for all other eligible countries
    and NGOs in an official partnership with UNESCO.

    3. Type of assistance requested
    Financial contributionImplementation by UNESCO field offices

    Type of assistance (Breakdown of expenditures) Indicate only the financial contribution requested of UNESCO In US $
    Conferences, meetings, translation and interpretation services, participants’ travel costs, consultants’ services and any other services deemed necessary by common accord (not including those of UNESCO staff members)/td>

    Seminars and training courses
    Supplies and equipment
    Study grants and fellowships
    Specialists and consultants – not including staff costs
    Publications, periodicals, documentation, translation, reproduction
      total
    4. (a) Description of the project
    Describe the project in detail indicating clearly the objectives and expected results (minimum of 1 to 2 pages)

    (b) Provide also the following elements of information
    Conferences/ meetings:
    Place (selection criteria):
    Duration:
    Conference agenda:
    Proposed topics:
    Proposed round tables:
    Working language(s):
    Number of participants:
    Participants’ travel cost:
    Participants’ daily subsistence allowance:


    Speakers (enclose curriculum vitae if possible)
    Intended audience
    MenWomenYoung Girls/BoysStudentsOutstanding Personalities

    Seminars and training courses:
    Proposed workshops:
    Number of beneficiaries:
    Intended audience
    MenWomenYoung Girls/BoysStudentsOther


    Proposed work plan:
    Purpose of the seminars/training:

    Moderators (selection criteria):

    Supplies and equipment:
    List of benchmarks (please refer particularly to the list of benchmarks annexed to the Participation
    Programme Circular Letter of the Director-General)

    Description of the material:
    Name of the supplier or manufacturer:

    For the material, please enclose without fail at least two (2) competitive (proforma) invoices for the
    purchase of professional goods and services for an amount equal to or greater than $5,000
    Pro forma invoice 1:
    Pro forma invoice 2:
    Pro forma invoice 3:

    Study grants and fellowships:
    Discipline taught/offered:
    Date and duration:
    Number of beneficiaries:
    Selection criteria of the fellows:
    Study plan:
    Name(s) of the selected candidates:

    Specialists and consultants:
    Tasks and assignments of the specialists or consultants
    Name (enclose curriculum vitae without fail):
    Specialists/consultants selection criteria:
    Duration of the mission:
    Honorarium (honorarium should not exceed 30% from the total amount requested from
    UNESCO):

    Publications
    Nature of publication and/or reproduction:
    Estimated cost of the reproduction or translation:
    Quantity, number of copies to be printed:
    Name of the publisher, as well as the date foreseen for translation and /or publication

    5.Description of estimated budget: the budget must be drawn up in United States dollars and
    clearly indicated in the main breakdown of expenditures (paragraph 3)


    Nota Bene: Administrative costs are not financed under the Participation Programme and should by no means be included in the estimated budget.
    6. 39 C/5* activity to which this project relates:
    39 C/5 paragraph No.

    7. Contribution from the Member State or NGO in United States dollars:

    8 Geographical coverage of the project (tick the appropriate box):

    National (up to $26,000)  
    Subregional (maximum $28,000) Project must be supported by at least two other Member States. Please attach two support letters (see model of support in Annex II)
    Interregional (up to $28,000) Project must be supported by at least two other Member States. Please attach two support letters (see model of support in Annex II)
    Regional (up to $38,000) Project must be supported by at least three other Member States. Please attach three support letters (see model of support in Annex II). Please note that activities of a regional character may be submitted only by Member States and are not included in the quota of seven requests.

    9. Name of the institution responsible for carrying out the project:
    National Commission or NGO in an official partnership with UNESCO:
    Name
    Mailing address:
    Phone number:
    E-mail address:

    10. Beneficiary institution(s):
    Name
    Mailing address:
    Phone number:
    E-mail address:

    11. In the case of financial contributions, please tick the appropriate box:
    Method of payment
    by bank transfer to the National Commission’s bank account or to that of the ministry responsible. Payment to a third party is not authorized.exceptionally, via field office upon UNESCO HQ’s approval. In this case the approved projects will be implemented by the field office concerned.by bank transfer to the NGO in an official partnership with UNESCO

    Currency of payment
    US dollarsEuroOther

    Communicate, by email, your bank details to the Participation Programme and Fellowships Section.

    12. The applicant accepts the conditions set out in 39 C/Resolution 61 on the Participation Programme, adopted by the General Conference.
    accept

    Name, stamp, signature and title of the Secretary-General of the National Commission for UNESCO or of the recognized representative of the Government (1) or of the nongovernmental organization in an official partnership with UNESCO