MEMBERSHIP - SCIC



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|Organizational Membership |

|Application Form |

|Applicant Information |

|Date of Application: |

|Name of Organization: |Acronym: |

|Mailing Address: |

|City: |Province: |Postal Code: |

|Phone: |Fax: |

|E-mail: |

|Website: |

|Facebook: |Twitter: |

|Additional online presence: |

|Designated Contacts |

|Primary Contact Name: |Secondary Contact Name: |

|Title: |Title: |

|Phone: |Phone: |

|E-mail: |E-mail: |

|Name of Contact Person in another part of Canada (if applicable): |

|Title: |Phone: |

|Email: |

|Name(s) of Additional Contact(s) who would like to receive information and updates from SCIC: |

|Email(s) of Additional Contact(s): |

|Do you consent to receiving electronic communications from SCIC (double-click and check the applicable box): |

|Yes |

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|No |

|Do you consent to have the organization’s logo and contact information to be displayed on SCIC’s website: (double-click and check the |

|applicable box) |

|Yes |

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|No |

|* Please contact SCIC if there are any changes to your contact information |

|Agency Profile | |

|Is your organization (double-click and check the applicable box): |

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|A non-profit organization registered in Saskatchewan |

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|A non-profit or charitable organization registered in Canada and working in Saskatchewan |

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|A SK based academic entity or research center affiliated with a recognized Saskatchewan College, University or School District |

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|A union, group, coalition, institution or private sector enterprise |

|Our organization is a: |Is your organization incorporated? (double-click and check the |

| |applicable box): |

|National Entity |Yes |

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|Provincial Entity |No |

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|A Branch |If yes, what is the incorporation number / charitable tax number? |

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|Number of Staff in SK: |Number of Volunteers in SK: |

|Number of Members in SK: |Do you work with Interns or Students? |

|Do you have an elected Board? |

|Does your organization have a strategic plan? |

|Does your organization have a communications and/or a digital engagement strategy? |

|Does your organization have audited financial statements? (double-click and check the applicable box): |

|Yes |

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|No |

|Please describe your organization’s work or interest in international cooperation, global and/or environmental justice and/or community |

|development. |

|Have you, or do you plan to bring Southern Partners to Canada or SK (double-click and check the applicable box)? |

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|Often |

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|Sometimes |

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|Never |

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|Please elaborate: |

|Do you organize activities for International Development Week (first full week of February)? |

|Does your work contribute to the United Nation’s Sustainable Development Goals? If so, in what way? |

|Membership Fees |

|Membership fees are based on a sliding scale according to the annual gross revenue of the organization. Membership renewals take place in |

|April of each year. |

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|$100 for organizations with an annual gross revenue of $50,001 and above |

|$ 50 for organizations with an annual gross revenue of less than $50,000 |

|What is your annual gross revenue? |

|Your Work |

|Please tell us what areas you work in, and the work that you do. |

|Area |Activity |

|Poverty Reduction / Elimination | |

|Hunger / Famine | |

|Health / Nutrition | |

|Quality Education | |

|Gender Equality, Women and Girls’ Rights | |

|Clean Water & Sanitation | |

|Affordable & Clean Energy | |

|Decent Work & Economic Growth | |

|Industry, Innovation, & Infrastructure | |

|Reduced Inequalities | |

|Sustainable Cities & Communities | |

|Responsible Consumption & Production | |

|Climate Action / Justice and Ecological Sustainability | |

|Life Below Water | |

|Life on Land | |

|Peace, Justice, & Strong Institutions | |

|Human Rights | |

|Indigenous Rights | |

|People’s Empowerment, Democratic Ownership and | |

|Participation | |

|Transparency and Accountability | |

|Corporate Social Responsibility | |

|Youth Engagement | |

|Other Thematic Issues: | |

|Other: | |

|How will your organization contribute to SCIC? |

|What experience or expertise do you bring to the network? |

|Area |Expertise |

|Public Engagement | |

|Media Relations | |

|Volunteer Management / Sending | |

|Project Management | |

|Financial Management | |

|Monitoring and Evaluation | |

|Fundraising | |

|Grant Writing | |

|Facilitation | |

|Organizing | |

|Advocacy | |

|Campaigning | |

|Other: | |

|Other: | |

|Why is your organization interested in joining SCIC? (double-click and check the applicable box): |

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|Networking and collaborating with other SCIC members |

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|Enhancing public engagement endeavours |

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|Professional development opportunities |

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|Skills development. In what areas? _______________________________________________________________________ |

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|Capacity building. In what areas? _______________________________________________________________________ |

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|Peer learning |

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|Access to funding through the Public Engagement Fund |

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|Promotion of your opportunities, events and announcements |

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|Increase reach through access to SCIC’s communications platforms |

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|Policy development and support |

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|Stay current with sector news and events |

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|Other_________________________________________________________________________________________________ |

|How will your organization benefit from being a member of SCIC? |

|What is your greatest challenge as an organization? |

|How did you hear about SCIC? |

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|Please add any other comments or information which you feel SCIC should know in considering your application. |

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|[pic] Please submit the following documents with your application form: |

|Annual Report for most recent year |

|Audited Financial Statement for most recent fiscal year |

|Mission Statement |

|Criteria, policies or guidelines used for overseas projects, development education advocacy activities |

|Agency Self-Assessment for Implementation of SCIC’s Development Principles |

|An electronic version of your logo |

|Any other documents (newsletters, educational materials, etc.) that may aid us in addressing your application. |

|Declaration |

|We have read the SCIC Mission Statement, Bylaws, the Membership Criteria and Statement of Development Principles. We concur with the principles|

|embodied in these documents and accept them as guiding our relationship with the Council. |

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|_______________________________________ _____________________________________ |

|SIGNATURE TITLE |

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|_____________________________________ |

|DATE |

|Submission |

|Please submit completed application form electronically to Denise at: |

|dmacdonald@earthbeat.sk.ca |

|Contact Us |

|Saskatchewan Council for International Cooperation |

|Address: 2138 McIntyre Street, Regina, SK, S4P 2R7 |

|Phone: 306.757.4669 |

|Email: dmacdonald@earthbeat.sk.ca Website: earthbeat.sk.ca |

|Twitter: @SaskCIC Facebook: SaskCIC |

|Web: earthbeat.sk.ca |

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