Application Form of Civil Society Platform (Mozambique)

1	Information on your organisation *Pleaes explainin why your organisation is eligible to be a Member Organisation for C-CfA.				(e.g. aim, history, membership, member organisations, activities, network, budget, human resource, etc.)
	§       Civil Society Platform §       The main aim is to facilitate the participation of Civil Society Organizations in policy dialogue leading to poverty alleviation, though involvement in planning, implementation, monitoring and evaluation of the national development plan, at all levels; §       More than one hundred members (Private Sector, trade Unions, Networks of non Governmental Organisations (NGOs), Technical and Professional Organizations, Academic and Research Institutions, Specific Organizations (which can also be NGOs), Interested Individuals) §       The main activities are: 1) elaboration of the Annual Report on Poverty (RAP); 2) facilitation of dialogue between Government, Civil Society and Donors around poverty reduction and development and 3) building of capacity of civil society at local level.
2	Name, position and contact of a person who is in charge of this commission
	Name: (Mr. / Ms.): Paulo Cuinica Position within the organization: Executive Secretary e-mail address: [e-mail] Telephone: + 258 21 355312                          Fax: + 258 21 355333 Skype name: *Please attach her/his CV.
	Reason why he/she is eligible to be in charge of a representative of your organization
	Currently is the Executive Secretary and in charge of representing the Platform with other parties.
3	Budget allocation for becoming a Member Organisation of C-CfA					e.g. its amount and how to be spent (in USDollar) USD2,000
4	List of NGOs that recommend your organisation to represent them		*Please fill out at least 10 names of organizations. *Contact should be postal address, telephone number and e-mail address (Website URL, if there is).
	Name1	CCM	Contact	Av. Agostinho Neto 1584 Phone: [phone]    Fax:[phone] E-mail: [e-mail]
	Name2	UNAC	Contact	Rua Valentim Siti, 39 Phone: [phone]   Fax: + 258 21 306738 E-mail: [e-mail]
	Name3	CTA	Contact	Rua de Castanheda, 120, Bairro da Summershild Phone: [phone]    E-mail: [e-mail]
	Name4	GMD	Contact	Av. Olof Palm, 236 Phone: [phone]    Fax: + 258 21 303867 E-mail: [e-mail]
	Name5	ABIODES	Contact	Rua Joaquim Lapa, 192 – 1º andar C.P. 2146 Phone: [phone]    Fax: + 258 21 314854 E-mail: [e-mail]
	Name6	FDC	Contact	Av. 25 de Setembro, Time Squere Bloco II – 3ºandar Phone: [phone]    Fax: + 258 21 355355 E-mail: [e-mail]
	Name7	Cruzeiro do Sul	Contact	Av. 24 de Julho, 285, 2º andar Phone: [phone]   Fax: + 258 21 493561 E-mail: [e-mail]
	Name8	Fórum Mulher	Contact	Rua Pereira do Lago, nº147 – 3º Dto Phone: [phone]    Fax: + 258 21 493437 E-mail: [e-mail]
	Name9	APOSEMO	Contact	Rua Francisco Matange, nº191 Phone: [phone] E-mail: [e-mail]
	Name10	CIP	Contact	Av. Amilcar Cabral 903 Phone: [phone] E-mail: [e-mail]
	Name11	KULIMA		Av. Karl Marx, 1452 R/C Maputo Mocambique Tel: [phone] 431665 Fax: [phone] Cel: [phone] E-mail: [e-mail]
	Name12	TEIA	Contact	Patrice Lumumba , 850, 1º andar Phone: [phone] E-mail: [e-mail]
	Name13		Contact
	Name14		Contact
	Name15		Contact
	Name16		Contact
	Name17		Contact
	Name18		Contact
	Name19		Contact
	Name20		Contact
* You may add more names of organizations if there are more organizations that are recommending your organization.

Application Form of MVIWATA (Tanzania )

1	Information on your organisation *Pleaes explain why your organisation is eligible to be a Member Organisation for C-CfA.				(e.g. aim, history, membership, member organisations, activities, network, budget, human resource, etc.)
	MVIWATA is a national organisation in Tanzania operating through networks of grassroots farmer groups. At present it comprises 75 networks bringing together 20,000 men and women farmers and 3,000 individual members. The network structure has been instrumental in ensuring good communication within the organisation and with external partners. There is a secretariat with competent staff under the national coordinator. There are also regional offices in some regions of Tanzania such as Mbeya, Kilimanjaro, Morogoro, Kagera etc.   MVIWATA is eligible to be a member organization for the C-CfA because it has a better coverage of Tanzanian National NGOs. Many civil society organizations collaborate with MVIWATA in many programs, thus it is easy for MVIWATA to gather the views of the CSOs and feed into the advocacy campaign towards the G8.   Another reason that gives MVIWATA the winning possibility is the fact that there is a strong secretariat at the national and regional levels, internet connection and other facilities that ease communication between MVIWATA and other CSOs. It is also possible to mainstream the tasks related to the C-CfA into the routine program follow up activities.
2	Name, position and contact of a person who is in charge of this commission
	Name: (Mr. / Ms.) Mr. Stephen A. Ruvuga Position within the organization: National Coordinator; P.O. Box 3220 , Morogoro e-mail address: [e-mail]; [e-mail];[e-mail] Telephone: : ++ 255-23-260-4184                      Fax: ++255-23- 260-4184 Skype name: No.            Cell: ++255 (0) 0744389247 *Please attach her/his CV. (to follow in a next sheet)
	Reason why he/she is eligible to be in charge of a representative of your organization
	- Mviwata is a network that represents the voice of farmer groups in Tanzania. It has a strong experience on the development issues that need to be addressed at national and international levels. It is this background that gives Mviwata the eligibility to apply to become a member of the C-CFA.
3	Budget allocation for becoming a Member Organisation of C-CfA					e.g. its amount and how to be spent (in USDollar) US$ 500
	This budget will be mainly for communication and coordinating the voices of CSOs in Tanzania. Of course this budget is too small, but we fill that most of the follow-ups will be combined with other activities that were earlier planned and budgeted for. In the future, MVIWATA will discuss with her funders to see how this work can be supported further.
4	List of NGOs that recommend your organisation to represent them		*Please fill out at least 10 names of organizations. *Contact should be postal address, telephone number and e-mail address (Website URL, if there is).
	Name1	VECO Tanzania	Contact	Mr. Mbarwa Kivuyo, P.O. Box 105516, Dar es Salaam [e-mail]
	Name2	Inades Formation	Contact	Mr. Alphone Katunzi, Tel. [phone] [e-mail] [e-mail]
	Name3	MIICO	Contact	Mr. Ikungasya D.A. Mwakatumbula; [e-mail] [e-mail]
	Name4	NGO Policy Forum	Contact	Getrude Mgenzi [e-mail]
	Name5	Sustainable Food Security Program (SFSP) – Chunya	Contact	Mr. Lawrence Limbe; Tel. [phone] [e-mail]
	Name6	Tanzania Association of Non-Governmental Organizations (TANGO)	Contact	Mrs Mary Mwingira P.O. Box 31147, Dar es Salaam [e-mail]
	Name7	Ileje Rural Development Organization	Contact	Mr. Simon Mwangonda. Tel. [phone] [e-mail]
	Name8	Isangati Agricultural Development Organisation	Contact	Box 1687, Mbeya Tanzania [phone] [e-mail]
	Name9	Lay Volunteers International Association (LVIA) Kongwa	Contact	[e-mail]
	Name10	ADP Mbozi	Contact	[e-mail] Box 204, Mbozi Mbeya, Tanzania [phone]
	Name11	Foundation HELP	Contact	Chacha Benedict Wambura P.O. Box 854 Musoma Tanzania Tel: [phone] Email: [e-mail]
	Name12		Contact
	Name13		Contact
	Name14		Contact
	Name15		Contact
	Name16		Contact
	Name17		Contact
	Name18		Contact
	Name19		Contact
	Name20		Contact
* You may add more names of organizations if there are more organizations that are recommending your organization.

Application Form of CSAP (Sierra Leone)

1	Information on your organization *Please explain why your organization is eligible to be a Member Organization for C-CfA.				(e.g. aim, history, membership, member organisations, activities, network, budget, human resource, etc.)
	As a Process, Platform and Forum here are our values:- Our Values System: 1.      Our vision: We believe that another Sierra Leone is possible. A Sierra Leone where all are equal before the law, corruption a thing of the past, gender equality the norm not exception, education a right and free etc. 2.      Mission: Our mission is to transform Sierra Leone into a country of dedicated citizens with values, skills, knowledge and adequate information. 3.      Our Values: We believe in the African Collective Leadership, respect for age, knowledge and the power of the people; strong resentment against corruption, gender inequality, sexual harassment, child and human trafficking, pornography etc. 4.        Note: Attached, please find the following documents relating to the Aims, history, membership, member organizations, activities, networks, pedagogy and work on HIPC/PRSP etc.
2	Name, position and contact of a person who is in charge of this commission
	Name: Mr. Falla Ensa-N’Dayma Position within the organization: National Co-ordinator e-mail address: [e-mail] Telephone:[phone]: Cell:[phone] /[phone] Fax:[phone] Skype name:fallakendeh_fen *Please attach her/his CV. Attached
	Reason why he/she is eligible to be in charge of a representative of your organization
	Mr. Ensa-N’Dayma, is a trained journalist with 30 years practice interspersed with trade unionism, community development, civil society activism, human and African peoples rights activities, agitation for PLWHA and minorities e.g. Gays etc.
3	Budget allocation for becoming a Member Organisation of C-CfA					e.g. its amount and how to be spent (in USDollar)
4	List of NGOs that recommend your organisation to represent them		*Please fill out at least 10 names of organizations. *Contact should be postal address, telephone number and e-mail address (Website URL, if there is).
	Name1	National Forum for Human Rights (NFHR)	Contact	29 Big Waterloo Street, Freetown. [phone], E-mail:[e-mail]
	Name2	Network Movement for Justice & Development (NMJD)	Contact	29 Main Motor Road, Freetown. [phone], Email: [e-mail], [e-mail]
	Name3	Trade Union Confederation of Sierra Leone (TUC-SL)	Contact	1 Regent Street, Freetown. [phone], E-mail: [e-mail]
	Name4	Coalition of Women’s Organizations – Eastern Region	Contact	1 Wesley Street, Kenema City, Eastern Region, [phone], Email: [e-mail]
	Name5	Centre for Democracy & Human Rights (CDHR)	Contact	24 Station Road, Makeni City, Northern Region, [phone], E-mail: [e-mail]
	Name6	Gender Awareness Programme (GAP)	Contact	6 Freetown Road, Moyamba Town, Southern Region. [phone]. No E-mail
	Name7	National Farmers Association of Sierra Leone (NAFSL)	Contact	2nd Floor, Old Agriculture Building, Tower Hill, Freetown. [phone], E-mail: [e-mail]
	Name8	Freetown Human Rights Committee	Contact	C/o UNIOSIL, Aberdeen, Freetown. E-mail: [e-mail]
	Name9	Campaign for Just Mining (CJM)	Contact	2 Suku Tamba Street, Koidu City, Kono District, Eastern Province, [phone]
	Name10	Vision for the Blind	Contact	24 Fort Street, Freetown. [phone], Email: [e-mail]
	Name11	Indigenous Transport Owners Association (ITOA)	Contact	140 Bai Bureh Road, Kissy, Freetown. [phone], E-mail: [e-mail]
* You may add more names of organizations if there are more organizations that are recommending your organization.

List of NGOs (The Nigerian Pro-Poor Governance Network)

4	List of NGOs that recommend your organisation to represent them		*Please fill out at least 10 names of organizations. *Contact should be postal address, telephone number and e-mail address (Website URL, if there is).
	NAME OF NGO	CONTACT PERSON	POSTAL ADDRESS	TELEPHONE NUMBER AND E-MAIL ADDRESS
	Environmental And Rural Medication Centre (ENVIRVMEDIC)	Itoghor O. Monday	No. 26, Eboh Road Warri, Delta State	[e-mail] 234-53-251732, 2348023296640; 234 8030945108
	Kwara Partnership Against Poverty	Aliyu A. Sadiq		[e-mail] 234 8033579767
	Hope for Village Child	Sister Rita	P.O. Box 3409 Kaduna	[e-mail] 234 8036696187
	UNDP	Samson Adayekun	UN House, plot 617/618 Diplomatic Zone, Central Distr. Area, Abuja.	[e-mail] 234 023452848
	YOTASCID	Yari Aduak	YOTASCID P.O. Box 58 Zonkwa	[e-mail] 234 8038068749
	Association of Women Living with HIV/AIDS in Nigeria (ASWHAN)	Doris Emmanuel Hajara Bala	No.4 Jaba Close Opp. FCT Office, Area 11 Abuja  OR 20 Aka-Itiam Road, Off Udo-Udoma Avenue Uyo Akwa Ibom	[e-mail] 234 8039114259; 234 8038068749
	CBD-NGO Forum	Rehab David	P.O. Box 13434 Jos Plateau State	[e-mail] [e-mail] 234 73 280434; 234 8037040355
	Justice Development and Peace Commission (JDPC)	Rev. F. Akinseloym	P.O. Box 400, Akure,	[e-mail] 234 8051133262; 234 8033504402
	CESODYO	M.J. Ahmadu	18A Okere/Kabba Road Lokongona Phase 1 Beside NAFDAC Office Lokoja	[e-mail] 234 8033886580 234 8055034575
	Society For Community Development	A. Apoede	P.O. Box 4339 Garki-Abuja	[e-mail] 234 8033141652
	ABANTU For Development	Ola Seyi Ayodele	P.O.Box 2604 Kaduna	[e-mail] [e-mail] 234 62-218890; 234 8038764130
	Centre For Environment, Human Rights and Development (CEHRD)	Patrick Naagbanton	6, Obo Nwanboke Street, P.O. Box 590, Ogale-Nchia, Eleme, Rivers State	[e-mail] [e-mail] 234 8033367823
	Civil Society Action Coalition on Education For All (CSACEFA)	Sarah Ochekpe	Flat 6 Doyin House beside PHCN, Wuse Zone 4 Abuja	[e-mail] 234 9 2900526
	Youth Advancement Organization of Nigeria (YAON), B/Kebbi	Haruna Alkasim	P.M. B. 1119, B/Kebbi	[e-mail] 234 8020531372
	Rev. Tor Uja	Benue SACA	C/o P.O. Box 1863, Markudi Benue State	234 8024524069
	Youth Awanreness, Advancement and Patrotic Association (YAAPA)	Abdulkarim Adamu	No. A, Isah Wasagu Road Off Sultan Abubakar Road,    GRA Sokoto	[e-mail] 234 8065119937
	Heal the Land Initiative In Nigeria (HELIN)	Kelechi Ihedimbu	No. 20 Aka Itiam Road, off Udo-Udoma Avenue, Uyo Akwa Ibom State	[e-mail] [e-mail] 234 8023350563
	Care For Life	Paulina Dogo	P.O. Box 105, Billiri, Gombe	234 8027653493
	Hope for Lonely (HFC)	Sarah Yapwa	P.O. Box 451	[e-mail]. 234 8059447785; 234 8059677330
	Centre For Creative Arts Education	Hilda Dokubo	10 Chief Ogbuga Street Ogbunabag, Port Harcourt.	[e-mail] [e-mail] 234 8036451488
	The Carpenter’s Foundation International (T-carp.Int’l)	Arc. Ibeheole, Julius	P.O. Box 12364 Garki Abuja	[e-mail] [e-mail] 234 9-7205319; 234 8033494865
	Women United For Economic Empowerment	Iniobong E. Frank	No. 70 Nwaniba Road-Ayo Akwa Ibom Street.	[e-mail] 234 805202528; 234 8027306816
	Save The World Organization (SAWOR)	John I. Ibekwe	256(94) Awka Road, (Near Mandilas Motors) Onitsha, Anambra State	[e-mail] [e-mail] 234 8033156139
	Participatory Development Alternatives	Victoria E. Eze	P.O. Box 180 Afikpo, Ebonyi State.	[e-mail] 234 8033156139
	Centre For Rural Integrations and Development	Lilian Nwokobia	4, Oheasiekwu Street, Umuagu, Asaba.	[e-mail] [e-mail] 234 8038991799; 234 8052480988
	Centre For Population And Development	Z.K.A. Bonat	12, KEFFI Road Barnawa G.R.A G. P.O. Box 7758 Kaduna.	[e-mail] [e-mail] 234 8037024794; 2348082085888
	Agape Foundation For Literacy And Rural Development	Pastor G.O. Odom  Ogazi Christopher	No. I.A. Ogoja Road Abakaliki Ebonyi State	[e-mail] [e-mail]  234 43-220519; 234 8062561771
	Applicants Welfare and National Development Centre	Ekanem Inyang	39 Kerin Lane, off Aka Road P.O. Box 1615 Uyo, Akwa Ibom Strate, Nigeria	[e-mail] [e-mail] [phone]
	Public Enlightenment Project (PEP)	Lilian Ezenwa	P.O. Box 1250 Katsina, Katsina State	[e-mail]  www.penigeria.org 234 803-5892100; 234 803-5892099
	Project Agape	David Allu	Opp. Savannah Guest Inn, Jos Road Lafia	[e-mail] [e-mail] 234 8035956554; 234 8055789482
	Educational Empowerment Initiatives Nigeria (EEIN)	Haliru A, Sadiq or Balarabe Hassan	No. A, Isah Wasagu Road Off Sultan Abubakar Road, P.M.B 2305, GRA Sokoto	[e-mail] 234 803-5892100; 234 803-5892099
	Federation of Muslem Women Association in Nigeria (FOMWAN)	Hon. Buzuwa Umar or Jamila Sani	FOMWAN Primary School Make RAR Gandu Area Birnin-Kebbi	[e-mail] 234 8038021440; 234 8020528696
	FORUM For African Women Educationalists (FAWE) Nigeria	Adelola Adegbesan	Sky-Memorial Complex, Block E, Flats 2, Wuse Zone 5 Abuja	[e-mail] [e-mail] 234 8027830082; 234 8034018944
	Nigeria Red Cross Society, Kebbi State Branch.	Ibrahim Abudullahi	Nigeria Red Cross Society Kebbi State P.O. Box 217 Gwadangaji Quarters Argogo Road B/Kebbi	[e-mail] 234 8025502565
	Youth Fate Renaissance	Borve Paago or Lebura Furubel	No. 20 Ekwe Street Mile 3, Port-Harcourt	[e-mail] 234 8037059566
	Development Exchange Centre Gombe (DEC)	J.C Makka	No. 5 Kaduna Road, Bauchi GRA P.O. Box 832 Bauchi	[e-mail] 234 8028349491
	Community Centre For Development (CCD) Sokoto	Ibrahim Adamu	P.O. Box 3851 Sokoto	[e-mail] [e-mail] 234 8035965517
	Kids and Teens Resource	Falana Martin-Mary	31,ilaje Street, Ijapo Estate, Akure, Ondo State	[e-mail] 234 8035606915
	Gender, Environment and Rural Development Initiative	Patricia Donli	1 Bama Road, Maiduguri	[e-mail]
	Keen and Care Initiative	Josephine Alabi		[e-mail] [phone]
* You may add more names of organizations if there are more organizations that are recommending your organization.

Application Form of the Nigerian Pro-Poor Governance Network (Nigeria)

1	Information on your organisation *Please explain why your organisation is eligible to be a Member Organisation for C-CfA.	(e.g. aim, history, membership, member organisations, activities, network, budget, human resource, etc.)
	Overview The Nigerian Pro-Poor Governance Network was an outcome of a one-day strategic meeting on pro-poor governance in Nigeria, held on 30 June 2005, after paper (3) presentation. The Network has over 50 member organizations (NGOs and CBOs) across Nigeria.   Vision Statement Complete extinction of poverty in Nigeria   Mission Statement To improve the standard of living for the poor and persons with disabilities (PWDs), empowering them to actively participate in transparent and accountable development of pro-poor policies, projects and programmes, budgetary formulation processes and expenditure tracking   Pro-Poor Governance Network Mandate §           Advocate, build capacity and lobby for pro-poor, gender sensitive poverty development policies, projects and programmes as well as enhance the participation of the poor and PWDs in the decision-making processes affecting their lives §           To raise funds and promote partnerships, networking and alliance building with relevant national and international stakeholders Our Strategic Focus §           The need to build a united voice of actors on pro-poor issues §           Building a critical mass movement of civil society working at local levels with shared agenda and clear purpose for social action §           Influencing pro-poor policies through strategic but constructive engagement with state and market actors §           Influence donors to adopt empowering processes and pro-poor programmes §           Engage and influence the formulation and implementation of pro-poor policies §           Facilitate exchange of ideas, information, best practices, experiences and collective social action on pro-poor issues §           To build the capacity of Pro-poor Governance Network members, partners and communities §           To conduct poverty related research that informs policy and actions
2	Name, position and contact of a person who is in charge of this commission
	Name: David Allu (Mr.) Position within the organization: National Coordinator e-mail address: [e-mail]; [e-mail] Telephone: [phone]           Fax: Skype name: *Please attach her/his CV.
	Reason why he/she is eligible to be in charge of a representative of your organization
	In the course of my development work I have pursued and strengthen dialogue and partnerships with International NGOs and Donors towards Poverty reduction. Working with Action Aid, Oxfam GB, Japanese International Development Agency, and Partners for Development programmes in different thematic areas have broaden my horizon and capacity to strategically engage Government and Donors on pro-poor and pro-civic issues. I have also attended a number of International meetings representing Nigeria or the Pro-poor Governance Network where we presented our position on issues. I do not only have a good knowledge of the dimensions of poverty in Africa, but have also been involved in using participatory as well as rights-based approaches to designing poverty eradication programmes.   I am computer literate, reliable and able to work enthusiastically under pressure, either within a team or alone. I work also in a multi-cultural environment. I am straightforward, positive, a fair person with a friendly disposition and a good sense of humour. I also possses have acquired very clear and concise written, verbal communication and presentation skills. A team player, who is analytical, independent, meticulous, resourceful and willingly to learn new things and take added responsibilities and challenges, I am positive that I would add value to  any social development work if given the opportunity to serve
3	Budget allocation for becoming a Member Organisation of C-CfA		e.g. its amount and how to be spent (in US Dollar)
	$200,000 (Two hundred thousand US Dollars) ·         Building the capacity of pro-poor Governance Network members, partners and communities ·         Conducting poverty related research that informs policy and actions ·         lobbying and advocating for pro-poor policies, projects and programmes at national and international levels ·         Promoting partnerships, networking and alliance building with relevant national and international stakeholders