General Information

Name of the Organization
Mailing Address		Select Your District Achham Arghakhanchi Baglung Baitadi Bajhang Bajura Banke Bara Bardiya Bhaktapur Bhojpur Chitwan Dadeldhura Dailekh Dang Darchula Dhading Dhankuta Dhanusa Dholkha Dolpa Doti Gorkha Gulmi Humla Ilam Jajarkot Jhapa Jumla Kailali Kalikot Kanchanpur Kapilvastu Kaski Kathmandu Kavrepalanchok Khotang Lalitpur Lamjung Mahottari Makwanpur Manang Morang Mugu Mustang Myagdi Nawalparasi Nuwakot Okhaldhunga Palpa Panchthar Parbat Parsa Pyuthan Ramechhap Rasuwa Rautahat Rolpa Rukum Rupandehi Salyan Sankhuwasabha Saptari Sarlahi Sindhuli Sindhupalchok Siraha Solukhumbu Sunsari Surkhet Syangja Tanahu Taplejung Terhathum Udayapur
Head of the Organization
Office Phone
Mobile Phone
E-mail
Fax
Website
Year Of Establishment

Type of Organization

(Please tick more than one box if applicable to your organization)

Goverment

University/Tertiary/Research Institution

Corporation/Company

Non-Government Organization

Community Based Organization (CBO)

Profit-making

Cooperative

Not-for-Profit

Private/Community School

Public/Institutional School

Training Institution

Business Organization

Field of Work/ Main Responsibilities

(Please tick more than one box if applicable to your organization)

Training

Training

teachers/facilitators early childhood educators parents officials training of trainers Others

Providing services for young children and families

Services

early childhood education and care health related nutrition related hygiene and sanitation related Others

Research
Advocacy and networking
Others

Your organization is mainly working for the benefit of:

(if applicable):
Only young children
Children and youth
Families
Women and children
Others

Reasons for Wanting to Become an Organizational Member of AECDN

WHY DOES YOUR ORGANIZATION/INSTITUTION WANT TO BECOME AN ORGANIZATIONAL MEMBER OF AECDN? (State in brief the reasons)
WHAT JOINT ACTIVITIES DO YOU ENVISION COLLABORATING WITH AECDN ON? (Proposed activities/expected outcomes/time frame)
WHAT KIND OF CONTRIBUTION WILL YOUR ORGANIZATION BE ABLE TO PROVIDE FOR THESE JOINT ACTIVITIES OR FUNCTIONING OF AECDN? (Manpower/technical expertise /funding/other in-kind contributions, please specify)

Declaration of Member’s Intent

By checking signature below, we hereby state that our organization, wish to become an Organizational Member of the Alliance for Early Childhood Development Nepal (AECDN) under the “Organizational Membership” category.

We agree to share and support the achievement of AECDN’s mission and objectives as well as strategic vision, and activities, which will, in turn, promote Early Childhood Development in Nepal.

(The person signing may be someone who is in charge of the Organization, department, or division depending on the size and type of organization).

Name:
Signature
Title:
Organization
Date: