ANNEX

“ANNEX IIa

Aid application to be submitted by the Member States as referred to in Article 4(1)

	Member State
	School year
	Indicative allocation of aid referred to in Article 4(3) and Annex II, expressed in EUR.
Q1	Availability to use more than the indicative allocation referred to in Article 4(3) and Annex II.	Yes	No
Q2	If No to Q1, allocation requested, in EUR	(in figures)	(in letters)
Q3	If Yes to Q1 maximum additional allocation requested, in EUR (in addition to the indicative allocation).	(in figures)	(in letters)”