Small Grants Application Form

Ma demande

0 - Eligible countries

* Champs obligatoires

Eligible countries *

Has your organization already been a recipient of the grant program? *

Yes

1 - My organisation

* Champs obligatoires

Name and acronym of organization *

Legal status *

Address *

Post Code *

City *

Country *

Phone *

Website *

2 - President

3 - Reference for the project

Mon projet

4 - General Information

5 - Context

6 - Main needs identified

7 - Objectives

8 - Activities

9 - Results

10 - Operational partners

11 - Files to attach

Copie des statuts officiels de la structure (EN)*

Activity report for the previous year of the structure*

Budget and account for the previous financial year of the structure* Certifiés par les autorités compétentes

Detailed project budget*

Toute référence de partenaires financiers et opérationnels de la structure

Tout document utile relatif au projet

12 - Budget

Amount of the grant requested from the Mérieux Foundation (in euros) *

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 *

En soumettant le présent formulaire, je déclare comprendre et accepter sans réserve la collecte et le traitement de mes données personnes conformément à la Politique sur les données personnelles et les cookies de la Fondation Mérieux. *