APPLICATION FOR UNESCO CLUB ACCREDITATION

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 DETAILSName of club

Official date of the creation of the club

AddressNo.

Street

Barangay

City / Municipality

Province

Region

Postal Code

Telephone(Area code)

(Telephone)

Fax(Area code)

(Telephone)

Email Address

Website

Social media of the clubEx)The URL of the club on any social network, like Facebook

Club Category(please put an X)Elementary / High School ClubCollege (or HEI) ClubLocal Government OfficeBusiness Council / Cooperatives / CSOs / NGOs

Program Sector(please put an X)EducationScience & TechnologySocial & Human SciencesCultureInformation & Communication

LogoCurrent number of club membersAge range ofclub members

MaleFemaleTotalFromTo

Current number of club officials

MaleFemaleTotal

Description of the club (Clubs history, rationale, mission, vision, objectives and current interests should be included)

Accomplished Activities/Project

DateName of activities that your club organized last three yearsVenueBrief description with main objective(s)

dd/ mm/ yy ~ dd/ mm/ yy

II. CONTACT DETAILS

Club Adviser (Surname) (Given Name)(M.I.)Mr.Ms.

Date of Birthdd/mm/yyYear of Joining the Clubyyyy

Club Designation

Mobile Number

Email Address

Facebook Account

Telephone NumberArea CodeTel. No.

Club Head (Surname) (Given Name)(M.I.)Mr.Ms.

Date of Birthdd/mm/yyYear of Joining the Clubyyyy

Club Designation

Mobile Number

Email Address

Facebook Account

Telephone NumberArea CodeTel. No.

Other Key Officer (Surname) (Given Name)(M.I.)Mr.Ms.

Date of Birthdd/mm/yyYear of Joining the Clubyyyy

Club Designation

Mobile Number

Email Address

Facebook Account

Telephone NumberArea CodeTel. No.

LIST OF ALL OFFICIALS

Designation in the clubComplete Name(FN, MI, GN)Mobile NumberEmail Address

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

III. ORGANIZATIONAL STRUCTURE

............Committee on Academics & ResearchCommittee on CommunityCommittee on Sports & RecreationSecretaryTreasurerAuditorClub HeadClub vice-president Ex)

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.)

EducationScience & TechnologySocial & Human SciencesCultureInformation & Communication

Others, pls specify

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

Name of activity

Rationale of activity

Brief description

Expected period/ date of implementationdd/ mm/ yy ~ dd/ mm/ yy

Target participants/beneficiaries

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: ________________________ Date: _________________________ Signature over printed name of the Club Head/Principal