Small Grants Application Form

My application

0 - Eligible countries

* Required fields

Eligible countries *

Has your organization already been a recipient of the Mérieux Foundation’s grants program? *

Yes

1 - My organisation

* Required fields

Name and acronym of organization *

Legal status *

Year created *

Address *

Post Code

City *

Country *

Phone *

Website *

Organization's mission *

2 - Legal representative of the organisation

3 - Contact person (legal representative or another member of the organization)

My project

4 - General Information

5 – Project objectives

6 – Context and justification for the project

7 – Project beneficiaries

8 – Expected results and activities

9 – Expected results and indicators

10 - Operational partners

11 - Files to attach

Registration certificate (or equivalent)*

Copy of the official statutes of the structure*

Rapport d’activités de l’année précédente de la structure*

Budget et compte de l’exercice précédent de la structure* Certified by the competent authorities

Budget détaillé du projet*

Any references to the organization's financial and operational partners

Any useful document relating to the project

12 - Budget

Amount of grant requested from the Mérieux Foundation *

Is the requested grant the only source of funding for the project? *

Yes

If no, please specify the number of requested donors (public or private), their name and the status of the application (obtained or being obtained) *

By submitting this form, I confirm that I am authorized to represent the applicant organization *

By submitting this form, I declare that I fully understand and accept the collection and processing of my personal data in accordance with Fondation Mérieux's Privacy Policy. *