Humentum Local Membership Application Form
Please fill out the following form to apply for local membership with Humentum. If you would prefer to use a PDF copy of the form, please download the form here: https://files.humentum.org/fl/LyRR09lgE0 and send to membership@humentum.org once completed.
Date: *
MM
/
DD
/
YYYY
Organization: *
Physical Address: *
Postal Address: *
City: *
Country: *
Your Name: *
Title:
Office Tel 1: *
Office Tel 2:
Email: *
Website:
Current Operating Budget: *
(in the country where you are applying for membership)
Year Founded:
The following questions will help us know if Humentum membership is the right fit for your organization
How did you learn about Humentum? *
How do you feel a Humentum membership can support your organization? *
What is your organization's mission? *
Briefly describe the kinds of programs your organization carries out *
Please feel free to attach a brief information piece that describes your programs
Does your organization work internationally or regionally? Where is your Headquarters? *
Does your organization give sub-grants? Roughly how many such partners do you have in your country? *
Please give us an idea of your funding mix. If you have government or multi-lateral donors, can you mention which agencies. *
Are you applying for membership as part of the "plus one scheme"? *
The "plus one scheme" means that if you are a grantee of a global Humentum member, you will be eligible for a free local membership
If yes, please indicate the name of your sponsoring grantor organization below
Please check the appropriate budget category below for dues calculation. *
The prices are after deduction of any applicable withholding taxes.
Required
The Humentum membership year is October 1 through September 30 of the next year. Membership dues will be prorated based on your start date.
If you have filled out all the details above, please hit the "Submit" button below. Applications will be reviewed by our Membership Committee. You should have a decision within two weeks. An invoice for the dues will be sent to you upon approval.
Submit
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