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Get SO Somalia NGO Consortium Registration Application Form 2012-2024

REGISTRATION APPLICATION FORM 2012 Please note You are required to fill in all the sections if a section is not applicable to your agency kindly indicate N/A. ORGANISATION DETAILS Agency Logo Agency Name Agency Profile/Brief Description Main Mission/Objective of the proposed organization Is your organization a non-governmental How long has your agency been operational in Somalia/land Membership of the Consortium is open only to agencies with current activities in Somalia Are you currently a member of the Somalia NGO Consortium Yes/No If this is a new application please explain why you would like to join the Consortium. Consortium activities Yes/No Does your organization understand commit to and agree to uphold and respect the principles of Independence Impartiality and Neutrality Yes/No Headquarter Information Place/Date of registration of the organization Registration Number Please attached a copy of the Contact Person Director/Desk Officer etc for verification purposes Somalia NGO Consortium Peponi Rise off Peponi Road P. REGISTRATION APPLICATION FORM 2012 Please note You are required to fill in all the sections if a section is not applicable to your agency kindly indicate N/A. ORGANISATION DETAILS Agency Logo Agency Name Agency Profile/Brief Description Main Mission/Objective of the proposed organization Is your organization a non-governmental How long has your agency been operational in Somalia/land Membership of the Consortium is open only to agencies with current activities in Somalia Are you currently a member of the Somalia NGO Consortium Yes/No If this is a new application please explain why you would like to join the Consortium* Consortium activities Yes/No Does your organization understand commit to and agree to uphold and respect the principles of Independence Impartiality and Neutrality Yes/No Headquarter Information Place/Date of registration of the organization Registration Number Please attached a copy of the Contact Person Director/Desk Officer etc for verification purposes Somalia NGO Consortium Peponi Rise off Peponi Road P. O Box 14762 - 00800 Nairobi Kenya Tel* 254 020 2607110/1 Fax 254 020 2607112 email info somaliangoconsortium*org Website www. somaliangoconsortium*org Address Email Address Telephone Number Fax Number Location Website Regional Office At Nairobi level if applicable Field Office Please list locations in the field e*g* Hargeisa Somaliland OTHER AGENCY DETAILS Year Agency Became Active in Somalia Partner NGOs in Somalia Number of International Staff working on the Number of National Staff working on the Agency Presence in Neighboring Countries PROJECT/PROGRAM DETAILS Plans for programming in 2012 Main donors for 2012 funding Annual Budget Please indicate figure is USD Please list the email addresses you wish to have included on the NGO Consortium mailing list 10 Max Please indicate the name and address of the person to be sent the invoice Once application has been cleared by the Focal Point team of the NGO Consortium you will be informed of how payments can be made through the contact email address that you will provide. .

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