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Global Affiliate Program Application Form
Global Affiliate Application
Please complete as thoroughly and as accurately as you can. You are welcome to print, complete offline and then send scan or fax back to
Alternatively, you are welcome to copy form into a word processor to complete offline.
Name of person applying (First, Last)
Title of person applying
Email address for organization contact:
Has this organization used another name in the past?
What other names have you used in the past?
Physical Address of Organization (Street, City, State/Province, Postal Code, Country)
Mailing Address of Organization (Street/PO Box, City, State/Province, Postal Code, Country)
What is the mission and purpose of your organization?
In which geographic region(s) does your organization operate?
Who are the primary beneficiaries of the activities of your organization?
What specific ways do you plan on supporting the above population in the next year?
What is the total estimated population of the primary beneficiaries your org anization plans to serve?
Who are some secondary beneficiaries of the activities of your organization?
Is your organization registered with the regional or national government?
Please explain the nature of this registration.
Does your organization have formal bylaws, articles of incorporation, or similar documents that describe the organization and structure?
Briefly describe what organization documents you have.
Briefly describe the history of your organization, its leadership, and activities.
Do you have any outstanding judgements or pending lawsuits against your organization?
Does your organization carry liability insurance of any kind? Explain below:
Are you affiliated with any other organizations or government agencies?
Does your organization have any brochures, or other publicity/outreach mater ials? Please describe:
Does your organization have a Facebook page? (If yes, paste URL below)
Does your organization have an account on Twitter? (If yes, paste the URL below)
Do you have a system for keeping track of income and expenses? Please explain:
What was your total revenue (in US Dollars) for the previous fiscal year?
What were the sources of this revenue?
What were your total expenses (in US Dollars) for the previous fiscal year?
How was this money spent?
Was the previous fiscal year a typical year for your organization? Please explain below:
Do you have a bank account, separate from any personal account, that you using for your organization? Please explain:
Supporting website URLs