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Membership
Memeber Application Form
Membership Application Form
We would like
to apply for CCC’s full membership
to apply for CCC’s associate membership
NGO Type:
Local NGO/Association
International NGO/Association
Foreign NGO/Association
Date registered in Cambodia:
With Ministry:
Name of all current Donor/Supporter:
Total Current Annual Budget:
About your NGO Profile
Full organization’s name (Khmer Language)
Full organization’s name (Foreign Language)
Acronym (Khmer and/or Foreign Language)
Vision
Mission
Value
Goal/aim/purpose
Organization’s history
Main sector (s)
Agriculture and Water
Land
Decentralization and Deconcentration
Legal and Judicial Reform
Education
Mine Action
Fisheries
Partnership and Harmonization
Food Security and Nutrition
Planning and Poverty Reduction
Health
Private Sector Development
Infrastructure Regional Integration
Public Administrative Reform
HIV/AIDS
Rural Water & Sanitation
Infrastructure Regional Integration
Other
Number of Staff
Total Staff
Female
Total Local Staff
Female
Total Expat Staff
Female
Project/Program (list down the title of your program or/and project)
Location Covered
Location
#Projects
Location
#Projects
Location
#Projects
Banteay Meanchey
Koh Kong
Siem Reap
Battambang
Kratie
Preah Sihanouk
Kampong Cham
Mondul Kiri
Stung Treng
Kampong Chhnang
Phnom Penh
Svay Rieng
Kampong Speu
Preah Vihear
Takeo
Kampong Thom
Prey Veng
Otdar Meanchey
Kampot
Pursat
Kep
Kandal
Ratanak Kiri
Pailin
Nation ide
Regional
International
Beneficiaries number (approximate number at the time apply for CCC membership)
Total Direct
Female
Total Indirect
Female
Types of Beneficiaries:
Women
Disabled People
Entertainment ladies
Students
People with HIV/AIDS
NGO staffs
Children
Religiosity
Factory workers
Farmers
Indigenous
Local authorities
Poor People
Youths
Others
Organization Contact
1) Office Contact
Address
Tel
H/P
PO Box
Fax
Email
Website
2) Executive Director/Country representative
Name
Position
Email
H/P
3) Primary contact for program
Name
Position
Email
H/P
4) Focal Person for Engage with CCC meetings
Name
Position
Email
H/P
5) Contact Person for Receiving Email of Grant/Funding Opportunity
Name
Position
Email
H/P
Expert Staff Contact
1) Human Resource
Name
Position
Email
H/P
2) Financial
Name
Position
Email
H/P
3) M&E
Name
Position
Email
H/P
4) ICT
Name
Position
Email
H/P
Membership’s pledge
I have read the CCC By-laws. I have fully understood principles, terms and conditions as stated in the By-laws and I and my organization commit to follow and comply with them.
Attachment File
Submit
Event Calendar
28 Mar 2023, Consultative Workshop on CSOs’ Inputs into the National Strategic Development (NSDP) 2024-2028
28 Apr 2023, M&E Learning Forum