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Novelty Intervention (K)

ASSOCIATE PARTNERSHIP
APPLICATION FORM
Novelty Intervention (K) is an independent Kenyan non-profit organization founded in early 2012.
We work to build individual and community resilience to disasters through innovative communityfocused and community-managed disaster risk reduction initiatives. The organization has developed
the Associate Partnership Programme to bring together a community of professionals and
practitioners from various sectors in order to support Novelty Intervention (K) in fulfilling our vision
and mission.
The programme is in upholding the values of Excellence, Participation and Accountability in our
operations. Thank you for considering joining this growing community.

NOTE: The information provided in this application form will be kept confidential
and protected.
About Your Commitment
YOUR PERIOD OF COMMITMENT
I would like to commit myself to Novelty Intervention (K) as an Associate Partner for the following
number of years:
2 Years

5 Years

10 Years

15 Years

Part 1: About You


PERSONAL DETAILS
Full Name: _______________________________________________________________________
(Surname)
(First Name)
(Second Name)
Date of Birth: _____ / _____ / ________ (dd/mm/yyyy)

Sex: Male

Female

Nationality: ____________________________ Country of Residence: ________________________


County of Residence: ______________________________
Postal Address: ____________________________________ Postal code: __________________
Email Address: _____________________________________________________________
Telephone: ______________________________ Fax: ______________________________
Mobile: ________________________________
Your Occupation: __________________________________________________________________
Part 2: About Your Organization
YOUR ORGANIZATION
Name of your Organization: __________________________________________________________
Type of Organization:
Government

UN Agency

Foundation

Corporate Organization

International NGO

Local NGO

Academic Institution

FBO
Other (Please Specify)
_______________________________________________
Your role in the organization: _______________________________________________

CBO

Part 3: About Your Education


POST-SECONDARY EDUCATION
Please record details of the courses you have attended in the past. If this space is not sufficient, you
may indicate details of additional courses at the back of this form.
COURSE NO.1
Educational Level:
Certificate
PhD

Diploma

Undergraduate

Masters

Other (Please Specify) _____________________________________________________

Course: __________________________________________________________________________
Name of Institution: _________________________________________________________________
Type of Institution:

University

College

Polytechnic

Other (Please Specify) _________________________________ Year of Study: _____________


COURSE NO.2
Educational Level:
Certificate
PhD

Diploma

Undergraduate

Masters

Other (Please Specify) _____________________________________________________

Course: __________________________________________________________________________
Name of Institution: _________________________________________________________________
Type of Institution:

University

College

Polytechnic

Other (Please Specify) _________________________________ Year of Study: _____________


COURSE NO.3
Educational Level:
Certificate
PhD

Diploma

Undergraduate

Masters

Other (Please Specify) _____________________________________________________

Course: __________________________________________________________________________
Name of Institution: _________________________________________________________________
Type of Institution:

University

College

Polytechnic

Other (Please Specify) _________________________________ Year of Study: _____________


Part 4: About Your Skills and Experience
SKILLS & EXPERIENCE
Years of Work Experience:
0 2 Years

3 5 Years

6 10 Years

Over 10 Years

What range of Skills would you like to offer to the organization?


Financial Accounting & Management

Fundraising

Corporate Governance

Strategic Management

Public Relations & Marketing

Organizational Development

Project Management

Monitoring and Evaluation

Advocacy & Campaign

Research

Others(Please Specify)
_________________________________________________________________________________
_________________________________________________________________________________

Part 5: Organizational Support


SUPPORT PREFERENCES
How would you like to support the organization?
Financial Support

Advisory Support

Technical Support

Legal Advice/Support

Consultancy

Other (Please Specify) ___________________________________________________________


_________________________________________________________________________________
Part 6: Declaration
DECLARATION
I declare that the information provided on this application is complete, correct and fully discloses all
details concerning my eligibility criteria as requested by Novelty Intervention (K).
I understand and agree that all information provided in this application will be verified by the
organizations authorized representatives. I also understand that false/misleading statements may
lead to the refusal of the application or termination of the partnership.
I understand and acknowledge that under no circumstance will political activities be tolerated at the
organization. This type of activity will be cause for immediate termination of this partnership.
I understand that information provided in the application will be carefully reviewed, kept confidential
and protected by the organization.
Applicants Signature

Date of Application:

_______________

__________________

Name of Applicant: ________________________________________________


For Official Use
STATUS OF APPLICATION
Application Status:

Approved

Rejected

Withheld

Signature

Date of Approval/Rejection/Withholding:

_______________

__________________

Name of Official: ________________________________________________