10YFP Consumer Information Programme for Sustainable Consumption and Production - Application Form (Partner)[1]
Thank you for your interest in joining the Consumer Information Programme for Sustainable Consumption and Production of the 10 Year Framework of Programmes on Sustainable Consumption and Production (10YFP CI-SCP). Becoming a 10YFP CI-SCP Partner will open up opportunities for collaboration, help to showcase or scale up your work, and provide a platform to share your insight and experience with relevant organisations and initiatives.
In order for the 10YFP CI-SCP’s Multi-stakeholder Advisory Committee (MAC) to approve your application, we kindly ask you to fill in and sign this form, as well as the partner declaration (Annex 1). The programme’s Coordination Desk may request additional information from applicants if necessary.
Please note that requests for funding will not be considered through this application process.
1. Information on the organisationName of the organisation/expert
Type of organization / National, regional, or local governments, government agencies and/or authorities (including public-private entities).
International organisations (including UN bodies, International Financial Institutions – IFIs, regional cooperation institutions).
Non-governmental organisations (NGOs), foundations, civil society organisations, and not-for-profit organisations (NPOs).
Academic institutions / Research centers or education institutions and associations (including schools, higher-education institutions).
Industry, industry associations, business organisations, individual companies, private sector representatives.
Experts, individual consultants.
Partnerships, networks, consortium (please provide list of members in separate attachment)
Media
Other: ………………………………………………………….
Description of your organisation/expertise
Thematic area of interest within the 10YFP CI-SCP programme / Improve availability, accessibility and quality of consumer information;
Drive change in business and government;
Enhance communication to drive behavioural change.
Website
2. Main contact of your organisation
Title / First name / Last name
Email / Mailing address
Telephone / Fax / Country
Please provide details of other alternate contacts of your organisation (if applicable):
3. Geographical Scope
In which world regions do you mainly operate? (please check all that apply) / Global (Covers all regions listed below)
Africa / North Africa
West Africa
East Africa
Central Africa
South Africa
Americas / North America
Central America
South America
Caribbean
Asia / East Asia
Middle Asia
South Asia
South-East Asia
Europe / West Europe
Central-East Europe
South Europe
North Europe
Oceania / Australia
New Zealand
Melanesia
Micronesia
Polynesia
4. Interest and description of project(s)
What is your interest to participate in the CI-SCP Programme? (please check all that apply) / Offer technical expertise in the area of CI-SCP and/or share knowledge:______(identify the relevant sub-area[2])
Propose new activity[3] (please fill section 4.1)
Bring ongoing activity1(please fill section 4.1)
Adapt, replicate or scale-up projects at national or regional level(please fill section 4.1)
Coordinate a work-area, or a sub-work area, participate in a working group: ______(identify which one[4]) / Provide funding for the CI-SCP or projects.
Fund raise for projects (please fill section 4.1, detailing your project and indicating the amount sought. Please note that request for funding is not part of this application).
Showcase developed projects that can be replicated elsewhere (please fill section 4.1).
Provide or receive capacity building in the area of CI-SCP (please fill section 4.2)
Other (please describe in section 4.3)
4.1 Description of proposed participation in the programme[5] (please add as many activities as necessary)
Activity 1
1. Description of the activity, entity in charge (in case of partnership, please describe the role of each entity)
2. Objectives and result expected (include geographical coverage, target audience or beneficiaries, explain how the activity would contribute to achieving the programme’s objectives)
3. Outputs and deliverables
4. Budget and timeline (indicate whether funds are fully, partially or not secured) / Please indicate to which work area / sub-work area this activity would contribute
4.2 Participation in Capacity Building Activities[6]
Particular interest in relation with the area of the programme:
If your institution / organization interested in providing capacity-building, please indicate:
Description of the capacity-building activity (objectives, target audience, tools, timeline):
Staff and time allocated (per year), if relevant: / If your institution / organization interested in requesting capacity-building, please indicate:
Description of the capacity-building activity (context, specific needs, objectives, target audience, timeline):
4.3 Other contributions, participation, please describe below:
5. Tools and Resources
If applicable, please list your portfolio of methodologies, communication resources, publications, guides, manuals, etc. relevant to the programme (include links if possible).
STATEMENT OF COMMITMENT
We confirm that [name of organization / entity] supports the vision, goal and objectives of the Consumer Information Programme (CI-SCP) of the 10 Year Framework of Programmes on Sustainable Consumption and Production (10YFP). We hereby commit:
· To sharing knowledge and experiences with the community and partners of the 10YFP CI-SCP programme, including through the Global SCP Clearinghouse (www.scpclearinghouse.org);
· To participating in 10YFP CI-SCP programme implementation as indicated above;
· To working in a collaborative spirit within 10YFP CI-SCP programme networks;
· To following the 10YFP Secretariat’s instruction with regards to the use of the 10YFP logo, and to sharing with the Coordination Desk of the programme any publication that references the 10YFP CI-SCP programme prior to disclosure;
· To providing regular updates and/or reports to the Coordination Desk on our activities and results, that have contributed to the 10YFP CI-SCP, including at least one (1) annual report on progress, describing the execution of and lessons learned from our activities, how these directly contribute to the 10YFP CI-SCP objectives, as well as an evaluation of reported measures on the results of these activities. This report should disclose funding sources for the participation of [name of organization / entity] in the Programme, including in-kind support and direct financial support;
· To indicating our willingness to continue supporting and contributing to the 10YFP CI-SCP annually, through renewal of this commitment.
For the private sector / NGO / non-profit organizations only:
We commit to the mission and objectives of the 10YFP CI-SCP and hereby enclose our signed and dated declaration form.
For governments / government agencies:
As the representative of the government of […..] and/or the [name of the institutions / office], I confirm that the information provided above is true and correct.
Signature
Date
Please return this application, along with other requested documents as relevant, filled and signed to: .
[Date]
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Application form –10YFP CI-SCP– April 2016
ANNEX I
FROM: [NAME OF ORGANIZATION]
TO: 10YFP CI-SCP
DECLARATION FOR NON-STATE ENTITIES
Organization Details / True or Yes / False or No / Supporting links or documentation EnclosedPart A: UN Values and Conventions
1. Our organization does not violate sanctions established by the UN Security Council
2. Our organization is not complicit in human rights abuses
3. Our organization does not tolerate forced or compulsory labor or the use of child labor
4. Our organization is not involved in the sale or manufacture of anti-personnel landmines or cluster bombs
5. Does the organization produce banned chemicals such as ozone depleting substances etc.?
6. Will the organization support the core values and goals of the UN/UNEP as expressed through its conventions such as the Millennium Development Goals and other multi-lateral environmental agreements?
Part B: Organizational Details
7. Legal status – certificate local/regional registration &/or incorporation
8. Does the organization have any legal encumbrances?
9. Are the organization’s financial statements periodically audited and available?
10. Does the organization have a track record in activities related to the 10YFP CI-SCP?
I, the undersigned, as the authorized signatory for the [Name of your entity] hereby declare that all statements made above are certified true and correct and that our organization commits fully to supporting the goals and objectives of the 10YFP CI-SCP.
SIGNATURE
[NAME]
[POSITION/TITLE]
SIGNED AT:
DATE:
For Internal Use OnlyApplication Received by the Coordination Desk on date: / By:
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Application form –10YFP CI-SCP– April 2016
Annex 2
Contact the Coordination Desk of the CI-SCP
Email:
Ian Fenn, Consumers International
Email:
Telephone: 00 44 20 7226 6663 + extension 229
Skype: ianmfenn1
Vrilly Rondonuwu, YPB, Indonesia
Email:
Telephone: 00 62 819 325 64649
Skype: plilit
Bettina Heller, UNEP
Email:
Telephone: 0033 1 4437 4277
Skype: bettina.heller85
Contact the 10YFP Secretariat
10YFP Secretariat
United Nations Environment Programme – Division of Technology, Industry and Economics
1 rue Miollis, Building VII
75015 Paris
Web: www.unep.org/10yfp
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Application form –10YFP CI-SCP– April 2016
[1] For more information on the 10YFP and its programmes, please refer to the “Guidance document on the 10YFP PROGRAMMES: Criteria, structure and steps to develop and operationalize them” developed by the 10YFP Secretariat. Available at www.unep.org/10yfp and http://www.unep.org/10yfp/Portals/50150/Guidance_Doc_10YFP_Programme%20development_1_V1_March14.pdf
[2] Refer to the 10YFP CI-SCP programme document (http://www.unep.org/10yfp/Portals/50150/downloads/sub-work_areas_CIP_programme_Nov2014.pdf).
[3] New and ongoing activities proposed (in partnership or as single entity) should be in line with the programme document http://www.unep.org/10yfp/Portals/50150/downloads/sub-work_areas_CIP_programme_Nov2014.pdf
[4] Refer to the 10YFP CI-SCP document and work plan approved work plan http://www.unep.org/10yfp/Portals/50150/downloads/sub-work_areas_CIP_programme_Nov2014.pdf
[5] Please add as many activities as necessary
[6] Partners taking part in capacity building activities will be asked to complete a detailed evaluation form which will contribute to the monitoring and reporting of the programme.