APPLICATION FORM AFFINNITY GROUP OF NATIONAL ASSOCIATIONS 1 PLEASE

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CIVICUS SURVEY OF NATIONAL ASSOCIATIONS OF NGOs/NPOs

APPLICATION FORM

AFFINNITY GROUP OF NATIONAL ASSOCIATIONS

please check one of the following:

a.	We would like to join as a new member of the CIVICUS Affinity Group of National Associations (AGNA).
b.	We would like to renew my/our membership with the CIVICUS Affinity Group of National Associations (AGNA)

AGNA Membership Requirements

1) Submission of this completed survey to [email protected]

2) It is also highly recommended that AGNA Members join CIVICUS Membership. Currently, there are no fees to join AGNA, but we urge AGNA Members who are not currently registered as a CIVICUS Members to register as CIVICUS members.

* For information on CIVICUS Membership, please contact the Membership Team at [email protected] . On-line registrations can be performed on the CIVICUS website at

http://civicusmembershipssite.azurewebsites.net/.

About your association:

a.	Name:
	English name (if applicable):
b.	Postal address:
c.	City:
d.	Country:
e.	Email(s):
f.	Website:
g.	Mission:
h	Name of person(s) who will serve as point of contact with AGNA
i	Position of person(s) who will serve as point of contact with AGNA
J	Email of person(s) who will serve as point of contact with AGNA
K	Skype contact details and Facebook/twitter contacts of organisation

Geographic area your members/activities cover:

a.	Country:
b.	Region:
c.	Other (please specify):

year your association was established:

National and international networks your association is a member of:

a.
b.
c.
d.

Please describe the main types of services that your assocation offers its members

please describe the criteria an organisation has to fulfill to become a member of your assocation (if possible please provide a link to respective website, attach a document or write here):

how many organisations comprise your membership (How many members does your organisation have)?

What types of organisations comprise your membership and how many? Please check all that Apply and number

NGO/NPO	Faith-based orgs	Grantmakers
Community-based orgs	Trade/Labour unions	Academic institutions
Businesses	Government ors	Cooperatives
Other (specify)	Other (specify)	Other (specify)

Please tell us how your association is funded:

	Article	% of total income a year
a.	Membership Dues
b.	Grants: International
c.	Grants: National
d.	Government: Grant
e.	Government: Service agreements
f.	Income from services
g.	Other self-generated income (from sales, events, rentals, etc.)
h.	Support from businesses
i.	Other (specify)
	TOTAL	100%

Please share your views with us on the subject matter that is most important to your association (1=High Priority; 5 =Low priority)

Subject	1	2	3	4	5
Raising and maintaining the public image of the nonprofit sector
Establishing an enabling legal environment for the sector
Convening the nonprofit sector
Linking the nonprofit sector with government, public sector and other key institutions in the country, building cross-sector relationship
Strengthening the accountability of the sector at large (e.g. generating a Code of Ethics/Conduct)
Increasing financial sustainability for members and the sector at large
Training/ capacity building for NGOs/NPOs
Influencing public/ government policy via advocacy, campaigning and participation
Increasing the business sector’s engagement with NGOs/NPOs
Other (please list):

Please share your views about the potential roles of the Civicus Affinity Group of NGO Associations that would be most valuable to your assocation. Please describe the 3 – 5 most important ideas here:

Please indicate whether your assocation can utilize information in the following languages. please note that affinity group uses English as its main language although it is trying to introduce french and spanish in its communications:

English YES NO

Spanish YES NO

French YES NO

Other

Please let us know if there is anything else of concern or interest to your assocation:

Thank you.

Please return the survey to [email protected]

2018 INTERNATIONAL SUMMER SCHOOL COURSE TEACHING APPLICATION FORM
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