Membership Application Form
We would like
NGO Type:
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)
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#ProjectsLocation#ProjectsLocation#Projects
Beneficiaries number (approximate number at the time apply for CCC membership)
Total Direct
Female
Total Indirect
Female
Types of Beneficiaries:
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
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