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["1A - Local Small Scale Project Identification Form"]
["Project Title                                                (short yet clear)",{"$nulls":6},"Project Number                                                            (assigned by Embassy)"]
["Country",{"$nulls":6},"Project Location"]
["Beginning of Project (month / year)",{"$nulls":6},"Termination of Project               (month / year)"]
["1. Requested Funding from the Czech Republic Official Development Assistance"]
["In CZK (according to Czech Embassy Exchange Rate)"]
["In Local Currency "]
["2. Additional Funding from Other Sources (if applicable)"]
["In CZK (according to Czech Embassy Exchange Rate)"]
["In Local Currency "]
["3. Total Project Budget"]
["In CZK (according to Czech Embassy Exchange Rate)"]
["In Local Currency "]
["4. Applicant"]
["Name of Organization"]
["Acting By and Through (name and position)"]
["Telephone Number"]
["Email Address"]
["Fax Number"]
["Website"]
["5. Description of Development Problem, Suggested Intervention and Project Results (max. 20 lines)                                                                                                                                       Brief description of the current situation which is to be targeted by the local small scale project (problem analysis, major problems to be resolved), intervention to resolve the problem and list of expected direct/tangible results of the project                                                                                      "]
[]
["6. Project Activities  (max. 20 lines)                                                                                                                                                                                                                                                                       List of activities to be carried out in order to achieve the above mentioned project results                                                                                                                                                                                     "]
[]
[]
["7.      Budget Proposal in Local Currency and CZK                                                                                                                                                                "]
["(Funding from the Czech Official Development Assistance Only)"]
["Budget Category**","Type of Costs",{"$nulls":5},"Unit","Number of Units","Unit Price in Local Currency","Total Costs in Local Currency"]
["1. Material, Goods, Equipment",{"$nulls":9},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[null,"Total of Material, Goods, Equipment in Local Currency",{"$nulls":8},0]
[null,"Total of Material, Goods, Equipment in CZK (according to Czech Embassy Exchange Rate)",{"$nulls":8},0]
["2. Contracted Personal Costs and Per Diems*",{"$nulls":9},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[null,"Total of Contracted Personal Costs and Per Diems in Local Currency",{"$nulls":8},0]
[null,"Total of Contracted Personal Costs and Per Diems in CZK (according to Czech Embassy Exchange Rate)",{"$nulls":8},0]
["3. Travel Costs*",{"$nulls":9},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[null,"Total of Travel Costs in Local Currency",{"$nulls":8},0]
[null,"Total of Travel Costs in CZK (according to Czech Embassy Exchange Rate)",{"$nulls":8},0]
["4. Other Contracted Services",{"$nulls":9},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[{"$nulls":10},0]
[null,"Total of Other Contracted Services in Local Currency",{"$nulls":8},0]
[null,"Total of Other Contracted Services in CZK (according to Czech Embassy Exchange Rate)",{"$nulls":8},0]
["Grand Total Requested from the Czech Republic Official Development Assistance in Local Currency",{"$nulls":9},0]
["Grand Total Requested from the Czech Republic Official Development Assistance in CZK (according to CZ Embassy Exchange Rate)",{"$nulls":9},0]
["*Total of Contracted Personal Costs, Per Diems and Travel Costs is not to exceed 25 % of the requested Grand Total Requested from the Czech Republic Official Development Assistance."]
["** Any potential change  exceeding 10 % of the Total Costs of any Budget Category that may occur during the project implementation must be notified in written in advance to the Embassy of the Czech Republic to be formally approved.  "]
["8.      Final Clauses"]
["Done in (city)"]
["Done on (date)"]
["Submitted by (name and position)"]
["Telephone"]
["Email"]
["Signature and Stamp"]