Changes between Initial Version and Version 1 of apc_membership_app

Timestamp:

Apr 29, 2008, 6:58:05 PM (17 years ago)

Author:

alfredo

Comment:

APC,membership

apc_membership_app

@@ +1 @@
+APC Membership application form
+
+Thank you for your interest in APC membership.
+
+This is the APC membership application form, which is part four of the APC Membership Information Pack.
+
+It is important that you read the first three parts of the information pack before completing the application form, which are available on-line at: http://www.apc.org/en/members/membership/becoming-a-member
+
+Please answer every question unless a question is marked optional and send your completed application form, together with any additional material in support of your application, by email to: membership@apc.org
+
+You will receive a reply within 2 weeks telling you when your application will be reviewed.
+
+APPLICATION FORM
+
+1. YOUR CONTACT DETAILS
+
+Please identify one person at your organisation that APC can liaise with regarding your membership application.
+
+a)Name b)Position c)Street/postal address (if different from the organisation street/postal address in 2. below) d)City/town e)State/province/other (optional) f)Country g)E-mail h)Telephone i)Fax
+
+2. YOUR ORGANISATION'S DETAILS
+
+a)Name of organisation b)Street address c)Postal address (optional) d)City/town e)State/province/other (optional) f)Country g)Telephone h)Fax i)Email Address j)Website k)Your organisation is: I.Registered/incorporated non-profit [ ] II.Non-registered/non-incorporated non-profit [ ] III.Charitable trust [ ] IV.For-profit [ ] V.Other, please describe:
+
+l)Your organisation was registered/incorporated in I.City, Country: II.on (Date):
+
+m)You work: (Please mark all that apply.) I.internationally [ ] II.nationally [ ] III.regionally [ ] IV.locally [ ]
+
+3. YOUR WORK
+
+APC members are using ICTs in a variety of ways to empower and support organisations, social movements and individuals in and through the use of information and communication technologies to build communities and strengthen initiatives for the purpose of making meaningful contributions to equitable human development, social and gender justice, participatory political processes and environmental sustainability.
+
+They include working as ISPs, producing on-line content, training, providing consultancy services or technical support to others and policy advocacy and campaigning.
+
+What is essential in your responses to the following questions is that you can demonstrate that your organisation makes a positive impact on the level and quality of ICT use by the organisations and communities you serve.
+
+a). What is the mission of your organisation?
+
+b). What are the core values of your organisation?
+
+c). Please describe the programme areas and/or activities your organisation implements.
+
+For each area or activity, please describe the outcomes you are working for, achievements and challenges experienced, and the people (beneficiaries or target groups) who you think have benefited, or will benefit, from your work.
+
+Programme/Activity area 1 Description: Outcomes: Significant achievements: Challenges: Beneficiaries and target groups:
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+Programme/Activity area 2 Description: Outcomes: Significant achievements: Challenges: Beneficiaries and target groups:
+
+Programme/Activity area 3 Description: Outcomes: Significant achievements: Challenges: Beneficiaries and target groups: Programme/Activity area 4 Description: Outcomes: Significant achievements: Challenges: Beneficiaries and target groups:
+
+[Please add as necessary]
+
+d). Please describe any services, support or assistance you provide. For example, provision of email accounts and web hosting, training in ICT skills, refurbishment/servicing of hardware, FOSS migration services etc.
+
+Service/support area 1 Description: Beneficiaries and target groups:
+
+Service/support area 2 Description: Beneficiaries and target groups:
+
+Service/support area 3 Description: Beneficiaries and target groups:
+
+Service/support area 4 Description: Beneficiaries and target groups:
+
+[Please add as necessary]
+
+e). What is your vision/concept of development and social change, and what role do ICTs play in bringing about this change?
+
+f). How long has your organisation been working with ICTs to support development and social change?
+
+g). Why do you have a strong emphasis on ICTs in your work for development and social change?
+
+h). What do you think is the role of civil society in social change and development work?
+
+i). Does your organisation work with other 'stakeholders' in ICT work? For example, government, inter-governmental agencies, private sector entities, academia etc. If so, please briefly describe which stakeholders you work with and in what ways.
+
+Stakeholder group 1: Stakeholder group 2: Stakeholder group 3: Stakeholder group 4: Stakeholder group 5:
+
+
+j). Please describe any local, national, regional or global ICT policy processes you have been, or are involved in.
+
+k). Please list any alliances or networks your organisation is a member of.
+
+4. YOUR INTEREST IN APC
+
+Members of APC are organisations that agree with and work to further APC's mission. They work actively with civil society and social movements, using ICTs to empower and support others to build strategic communities and initiatives contributing to equitable human development, social and gender justice, participatory political processes and environmental sustainability.
+
+Please answer the following questions giving as much information as possible. The Membership Working Group relies significantly on responses in the application form in making its assessment.
+
+a). When and how did you get to know about APC?
+
+b). Have you worked, or do you work, with APC members and/or APC staff? If so, please describe the activity, noting the names of APC members and staff you have worked with.
+
+c). Why does your organisation want to be an APC member?
+
+
+5. STAFFING and GOVERNANCE
+
+a). Please describe your organisation's structure – including staff, volunteers and the areas they work in. For example - Management: 1 full time staff person; Training: 2 full time staff; Website maintenance (1 volunteer).
+
+b). Does your organisation have a governing body? If so, please describe the governance structure (e.g. executive board, management committee, board of trustees etc), how it is formed (e.g. by appointment, elected by the members) and the names of the members of your governing body.
+
+Governance Structure: Formed by/through: Members of governance body:
+
+6. FINANCING AND SUSTAINABILITY
+
+a). What is your annual budget in US dollars (USD)?
+
+b). How does your organisation sustain itself financially?
+
+c). Please list donor, private sector (or other) institutions who have supported your organization financially in the past two years.
+
+
+7. MEMBERSHIP FEES
+
+Please read the following guidelines for deciding what membership fee (based on your organisation's annual budget/expenses) is appropriate for your organisation.
+
+If your annual budget/expenditure is between: $0 – $50,000 the fees each year are no less than $300 $50,001 – $100,000 the fees each year are no less than $500 $100,001 – $200,000 the fees each year are no less than $1,000 $200,001 – $500,000 the fees each year are no less than $2,000 $500,000 – $1,000,000 the fees each year are no less than $5,000 $1,000,001 and above – you are invited to pay any amount more than $5,000 in dues. Note: Budget refers to your organisation’s annual income (including earned income, donations, and grants). If you need help determining the appropriate category for your organization, please contact us.
+
+a). Please indicate which APC annual membership fee you will pay. PLEASE NOTE - you must choose one of the six options for your application to be processed.
+
+$ 300 very small organisation from developing country [ ] $ 500 very small to small organisation [ ] $1,000 small to medium organisation [ ] $2,000 medium organisation [ ] $5,000 large organisation and small for-profit [ ] $5,001+ for-profit member [ ]
+
+Payment arrangements will be made if/when your application has been approved. The annual fee must be paid within 14 days of acceptance of your application for membership, and is not refundable. Non-payment after formal notice will result in automatic termination. The approved application is valid for three months after formal notice. Annual fees are revised periodically and members are advised three months prior to any increase.
+
+b). Please check the box below if you would like to discuss making an additional contribution. (Optional)
+
+Yes. We want to discuss making an additional contribution to support the work of APC. [ ]
+
+
+8. REFERENCES
+
+Please include the names of at least three organisations, including a contact person and their details (address, phone, email), with whom you have an active relationship, as references.
+
+Reference 1 a) Name Of organisation: b) Street Address/postal Address: c) City/Town: d) Country: e) Telephone: f) Fax: g) Email Address: h) Contact person: i) Relationship to Organisation:
+
+Reference 2 a) Name Of organisation: b) Street Address/postal Address: c) City/Town: d) Country: e) Telephone: f) Fax: g) Email Address: h) Contact person: i) Relationship to Organisation:
+
+
+
+Reference 3 a) Name Of organisation: b) Street Address/postal Address: c) City/Town: d) Country: e) Telephone: f) Fax: g) Email Address: h) Contact person: i) Relationship to Organisation:
+
+9. ADDITIONAL MATERIAL
+
+Please make sure you have included any additional material which supports your application, in your mail to: membership@apc.org
+
+
+Thank you for completing the APC membership application form and for your interest in APC.
+
+Receipt of your application form will be acknowledged by return and you will receive a message within 2 weeks or receipt of your application, informing you of when your application will be reviewed by the Membership Working Group.
+
+Many thanks and regards.
+
+
+Karen Banks Vanessa Purper Network Development Manager Network Development Assistant karenb@gn.apc.org vanessa@apc.org