Membership Application

PART A - Member Institution Information

1. Name of the institution

2. Full postal address of the institution

3. Office Telephone Number of Institution
(with dialing code)

4. Website address of institution
(with http:// or https://)

5. Category of Institution (Select only one category which best describes the type of the institution)

6. Nature of work of the Institution (Select multiple options if applicable)


7. Please describe means of engagement with LOGIN so far (Select multiple options if applicable)


PART B - Institutional Work Experience (For LOGIN to leverage institutional strengths, resources and capacities)

8. Please choose a theme/s that your institution has professional expertise and experience:

9. Help us to know more about your work such as specific sub-themes within the broader theme your institution works on and level of impact of your work.

Civic Engagement and Accountability

Sub-themes

Level of Engagement





Nature of Work (Please explain what do you do, with whom and how )

Gender and Social Inclusion

Sub-themes

Level of Engagement





Nature of Work (Please explain what do you do, with whom and how )

Capacity Building of Local Governments

Sub-themes

Level of Engagement





Nature of Work (Please explain what do you do, with whom and how )

Fiscal Decentralisation

Sub-themes

Level of Engagement





Nature of Work (Please explain what do you do, with whom and how )

Public Service Delivery

Sub-themes

Level of Engagement





Nature of Work (Please explain what do you do, with whom and how )

Conflict Resolution and Peace Building

Sub-themes

Level of Engagement





Nature of Work (Please explain what do you do, with whom and how )

Any other theme related to DLG

Sub-themes

Level of Engagement





Nature of Work (Please explain what do you do, with whom and how )


PART C - Membership to LOGIN

10. What and how can your institution contribute to LOGIN in terms of expertise, knowledge and experience?

11. Why is your institution interested in LOGIN? What are your institution's expectations from LOGIN?

12. Who will represent your institution in LOGIN?

      Details of Representative 1
Full Name

Designation

Official e-mail address

Official Phone No.

Mobile No.


      Details of Representative 2
Full Name

Designation

Official e-mail address

Official Phone No.

Mobile No.



Please confirm that you have gone through LOGIN Governance Document (provided as an annex to this form) and agree to adhere to the values, principles and working modalities described in it.


This Institution hereby endorses the values and purpose of LOGIN and subscribes to its principles.



Full Name

 
E-mail address

Designation

Date

Place





The membership of the institution in LOGIN will be confirmed once the final decision is communicated by LOGIN Secretariat.









Annexure - LOGIN Governance Document