Appendix A: Application for Membership in Promote Musharikat Coalition

Individual Activist or CSO Delegate

I am applying for membership as: □ Individual Activist □CSO Delegate/Representative - Name of CSO: ______

Your position/title with CSO______

FIRST NAME: ______LAST NAME(or father’s name): ______

Note: Last name is mandatory. Use 2ndname on your CV, university diploma or work ID. If none available, use father’s last name.

Province where you arecurrently living: ______City/District: ______

Note: Do not enter province where you were born, enter where you currently reside.

Cell No: ______Alternate Cell No. ______Email & Alternate Email: ______

Note: MUST provide your own, direct cell phone number and email which you access directly. Do not provide cell/email for relatives, friends or general office reception.

Gender: □ Female □Male Age: □ 18-35 years □ 36+ years Tazkera/National ID No. ______(Attach copy)

Education:□High School□BA □MA□PhD Field/Faculty ______University Name______

Current Employment: Organization Name: ______Job Title: ______

Are you an ELECTED Afghan government official or NATIONAL-LEVEL official? □Yes □No

Relevant Women’s Rights/Empowerment and Advocacy Experience:(Use back or separate page.)

Describe your relevant experience with women’s rights/empowerment, advocacy and other relevant areas you would bring to the Musharikat coalition.Specifically describe your experience in the following areas:

  • Experience with advocacy and initiatives supporting women’s equality, empowerment and participationand/or positive masculinity.
  • Knowledge of issues related to women’s rights and empowerment in Afghanistan.
  • Vision for Afghan women’s full participation in society.
  • Your CV may be attached to provide examples of your relevant experience

Relevant Training & Volunteer Experience:

□Promote Women’s Leadership Development (WLD)Jawana □Other Training ______

□Relevant Volunteer Experience ______

Association/Civil Society Network membership:______

Have you received support from any other USAID project? □Yes □No If yes, which project:

□ Women in Economy □ Women in Government □ Women’s Leadership Development □ RASANA □ USIP □ Other______

□ Musharikat Coalition Member
Name: ______/ □ Musharikat Employee
Name: ______/ □ Musharikat Grantee
Name of Organization: ______
Other USAID Promote Project:
□ Women in Economy
□ Women in Government
□ Women’s Leadership Development/Jawana / □ USAID Project (not Promote):
Name of Project:
□ Women’s Rights/Civil Society Network or Association Name:______/ □ Donor or Donor Project (not USAID)
Name of Donor: ______
□ Became aware of Musharikat Coalitions through this membership posting

I was recommended to apply for coalition membership by:

Name: ______Signature: ______Date: ______

NOTE: Submit this completed form to . Please be assured that all information provided will be closely held and not be shared with any other party, for any purpose, without prior consent.

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Version 2_30 June 2018