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APPLICATION FOR UNESCO CLUB ACCREDITATION

Deadline: 31 July 2015


For completion by the club head;
Please email in PDF format to naucp@unescoclubsph.org

I.

CLUB DETAILS
Name of club
Official date of the
creation of the
club

Address

Telephone
Fax

No.
Street
Barangay
City /
Municipality
Province
Region
Postal Code
(Area code)

(Telephone)

(Area code)

(Telephone)

Email Address
Website
Social media
of the club
Club Category
(please put an X)
Program Sector
(please put an X)

Ex)The URL of the club on any social network, like Facebook


Elementary
/ High
School
Club

College (or
HEI) Club

Local
Government
Office

Education

Science &
Technology

Social &
Human
Sciences

Logo

Business Council / Cooperatives /


CSOs / NGOs

Culture

Information &
Communication

Age range of
club members

Current number of club members

Male

Femal
e

Total

From

Current number of club officials

Male

Female

Total

To

Description of the club


(Clubs history, rationale, mission, vision, objectives and current interests should be included)

Accomplished Activities/Project
Date
dd/ mm/ yy ~
dd/ mm/ yy

Name of activities
that your club organized
last three years

Venue

Brief description with main


objective(s)

II.

CONTACT DETAILS

Club Adviser
(Surname)
Mr.

(Given Name)

(M.I.)

Ms.

Date of Birth
Club Designation
Mobile Number
Email Address
Facebook Account
Telephone Number

dd/mm/yy

Area Code

Year of Joining the Club

yyyy

Tel. No.

Club Head
(Surname)
Mr.

(Given Name)

(M.I.)

Ms.

Date of Birth
Club Designation
Mobile Number
Email Address
Facebook Account
Telephone Number

dd/mm/yy

Area Code

Year of Joining the Club

yyyy

Tel. No.

Other Key Officer


(Surname)
Mr.

(Given Name)

(M.I.)

Ms.

Date of Birth
Club Designation
Mobile Number
Email Address
Facebook Account
Telephone Number

dd/mm/yy

Area Code

LIST OF ALL OFFICIALS

Year of Joining the Club

Tel. No.

yyyy

Designation in
the club

Complete Name
(FN, MI, GN)

Mobile Number

Email Address

* Please include the Club Adviser/s. Do include middle initials of all officials.

III. ORGANIZATIONAL STRUCTURE

Ex)
Club Head

Club vicepresident

Auditor

Treasurer

Secretary

Committee on
Academics &

Committee on

Committee on
Community

IV. INTENT/REASON FOR APPLICATION

1) When and how did you learn about UNESCO Clubs?

2) Why does your club wish to be a UNESCO Club?

3) What kind of positive impacts do you expect to gain by joining UNESCO Clubs?

4) How do you think your club could contribute to UNESCO Clubs?

V.

PLANNED PROJECT/ACTIVITY

UNESCO National Commission of the Philippines has five different sectors; Education, Science
and Technology, Social and Human Sciences, Culture, Information and Communication. Each of
five sectors works to achieve global visions of sustainable development encompassing
observance of human rights, mutual respect and the alleviation of poverty, all of which are at the
heart of UNESCOs mission and activities. Ensure that these plans are aligned with the
abovementioned overarching objectives of UNESCO. For further information on UNESCOs
Medium-Term Strategy, please visit
http://unesdoc.unesco.org/images/0014/001499/149999e.pdf. Further information on five
sectors can be found at the official website for the UNESCO National Commission of the
Philippines, http://www.unesco.gov.ph.
For your reference, please see the UNESCO Calendar of events at http://goo.gl/TmOU41 .

What kind of activity does your club consider undertaking this coming year? Please indicate
particular sector that you wish to work with (Multiple choices are possible.)
Education

Science &
Technology

Social &
Human
Sciences

Others, pls specify

* Please use the same format below for each project/activity.

Culture

Information &
Communication

Planned Project/Activity
Name of activity
Rationale of activity

Brief description

Expected period/
date of
implementation
Target participants/
beneficiaries

dd/ mm/ yy ~ dd/ mm/ yy

Venue
Expected outcome

* Please use the extra sheet if necessary


Name of Club: ________________________________________________________________________
In my capacity as a Club Head, I undertake to ensure that my club organizes an activity related to
UNESCO themes at least once a year and sends a completed Annual Report to UNESCO National
Commission of the Philippines and National Association of UNESCO Clubs by 31st January of the
succeeding year. Failure to do so for two consecutive years will cause my club to be placed on the list of
inactive clubs.

Prepared by: ________________________

Date: _________________________

Signature over printed name


Noted by: ________________________
Signature over printed name
of the Club Head/Principal

Date: _________________________