Partner Organisation Application Form

Part A: PARTNER ORGANIZATION PROFILE

1. What is the Name of the Organization?Write the Correct Name of the Host Organization2. Address of the Organization (Location, Road, LLG, Postal Address, Phone Numbers etc)

3. Category does your Organization come under?Select only one appropriate category

Community BasedCivil SocietyFaith BasedNon-GovernmentGovernmentOthers

4. Write your valid Email AddressWrite email addresses clearly as it will be used for communications with the NVS team or for you to get the copy of your application.5. Attach proof of formal registration if applicableIPA, Cooperatives, Association Certificate etc. Take a clear photo using a phone camera and upload it

If you are trying to attach PDF or Word files of formal registrations, open your folder from here, Uncheck the default 'Image Files' on the right corner of the folder to "All Files." This will enable you to attach non-Image files easily. Should you continue to have issues attaching files, call the NVS Team on phone numbers: 7236 7128 or 7849 7586.

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6. Attach Organization StructureTake a clear photo using camera and attach it or attach from your computer.

If you are trying to attach PDF or Word files of your organisation etc, open your folder from here, uncheck the default 'Image Files' on the right corner of the folder to "All Files." This will enable you to attach non-image files easily. Should you continue to have issues attaching files, call the NVS Team on phone numbers: 7236 7128 or 7849 7586.

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7. List 3 stakeholders/ partners that your organization works with8. Provide the name of a reliable contact person from your organization9. Enter his /her phone number10. Enter his /her email address

Part B: PROJECT IDENTIFICATION

1. Project Name2. Describe the Nature of the ProjectProject Goal, Objective, Vision etc3. What is the need identified in the community that this project will address?100 Word Limit4. What Sector does your project come underHealthEducationAgriculture/LivestockGovernance/Law and OrderTourism & CultureEnvironmentForestryTransportFisheriesChurchesCommunity DevelopmentOthers5. Project SponsorIs there any financial support for this project?

6. Is there a technical person from the district who will work together with the volunteer?A technical person that the volunteer will be working with will be a district or LLG project officers or advisors to the project located at the project site.

YesNo

7. What is the expected duration of the project?This should not be more than 3 years

6 Months1 year1.5 years2 years3 years

8. Region where the project will beRegion of residenceSouthernMomaseHighlandsNew Guinea Islands9. ProvinceProvince of residenceCentralGulfMilnebayOroWesternNCDEastern HighlandsEngaSimbuSouthern HighlandsHelaJiwakaWestern HighlandsEast SepikMadangMorobeWest SepikARoBEast New BritianManusNew IrelandWest New Britian10. District it is inDistrict of residenceAbauGoilalaKairuku HiriRigoMoresby North EastMoresby North WestMoresby SouthKeremaKikoriAlotauEsa'alaKiriwina GoodenoughSamarai-MuruaIjivitariSoheNorth FlyMiddle FlySouth FlyDauloGorokaHenganofiKainantuLufaObura WonenaraOkapaUnggai BenaKandepKompiam AmbumLagaip/PorgeraWabagWapenamandaChuaveGumineKarimui/NomaneKundiawaKerowagiSinasina YonggamuglIalibu PangiaImbongguKagua EraveNipa KutubuMendi-MunihuKomo MargarimaTari PoriKoroba KopiagoAnglimp South WahgiJimiNorth WahgiDeiHagenBaiyer MulTambul NebilyerAmbunti DreikikirAngoramMaprikWewakWosera GawiYangoru SaussiaBogiaMadangMiddle RamuRaicoastSumkarUsino BundiWau BuloloFinschhafenKabwumLaeMenyamyaNawaeMarkhamTewai SiassiAitape LumiNukuTelefominVanimo GreenCentral BougainvilleNorth BougainvilleSouth BougainvilleGazellePomioRabaulKokopoManusKaviengNamatanaiKandrian GloucesterTalasea11. What local level government is it in?Name of the current LLGAmazonAromaCloudy BayTapiniGuariWoitapeHiriKairukuKoiariMekeoRigo CentralRigo InlandRigo CoastalGerehu UrbanWaigani/UniversityTokarara/HoholaTown/HanuabadaGordons/SaragaBoroko/KoroboseaBomanaKilakila/KaugereLaloki/NapanapaCentral KeremaEast KeremaKaintibaKerema UrbanKotidangaLakekamu TauriBaimuruEast KikoriWest KikoriIhuAlotauDagaHuhuMakamakaMaramatanaSuauWerauraDobuDuauWest FergusonGoodenoughKiriwinaBwanabwanaLouisiadeMuruaYaleyambaAforeOrobayPopondettaSafiaTufiHigaturuKiraKokodaTamataKiungaKiunga UrbanNingerumOlsobipStar MountainsBalimoBamuGogodalaLake MurrayNomadDaruKiwaiMoerheadOriomo BituriEast PangiaIalibu UrbanKewabiWiruIalibu BasinImbongguLower MendiEraveKaguaKuareAiyaKarintsLai ValleyMendi UrbanUpper MendiLake KutubuMt. BosaviNembi PlateauNipaPoromaDeiKotnaMt. HagenHagen UrbanBaiyerLumusaMulMt. GiluweNebilyerHuliaKomoUpper WageLower WageAwi PoriLake KopiagoNorth KorobaSouth KorobaHayapugaTagaliTari UrbanTebiAnglimpSouth WaghiJimiKolNorth WaghiNoduglWatabungLower AsaroUpper AsaroGahukuGoroka UrbanMimanaloKafentinaDunantinaFayantinaKainantu UrbanKamano 1Kamano 2AgarabiGadsup-TairoraYagariaMount MichaelUnaviLamariYeliaEast OkapaWest OkapaLower BennaUpper BennaUnggaiChuaveElimbariSianeBomai-GumaiGumineMount DigineKarimuiNomaneSaltGena-WauglaUpper-Lower KoroniglKerowagi UrbanKupKundiawa UrbanMitnande (Mt. Wilhelm)NiglkandeWaiyeTabare (Sinasina)Suai (Suwai)YonggomuglKandepWageAmbumKompiamWapi-YengisLagaipMaip MuritakaPaiela-HewaPilikambiPorgeraWapenamandaTsakMaramuniWabagWabag UrbanCentral GazelleInland BainingLassul BainingLivuan-ReimberVunadidir-TomaBitapakaDuke of YorkKokopo-Vunamami UrbanRaluanaCentral-Inland PomioEast PomioMelkoiSinivitWest Pomio-MamusiBalanatamanKombiuRabaul UrbanWatom IslandKavieng UrbanLovongaiMuratTikanaKonoagilNamatanaiMatalaiNimamarSentral Niu AilanTanirGasmataGloucesterKandrian CoastalKandrian InlandKove-KaliaiBali-WituBiallaHoskinsKimbe UrbanMosaTalaseaArawaWakunaiAtollsBukaKunuaNissanSelau-SuirTinputzBanaBuinSiwaiAua-WuvuluBalopaBisikani-Soparibeu KabinLelemadih-BupichupeuLorengau UrbanLos NegrosNali Sopat-PenabuNigohermPobumaPomutu-Kurti-AndraRapatonaTetiduAmbuntiTunap-HunsteinGawangaDreikikierAngoram-Middle SepikKeramKarawariMarienberg (Marienberg-Lower Sepik)YuatAlbiges-MablepBumbita-MuhianMaprik-WoraYamil-TamauiBoikin-DaguaTurubuWewak IslandsWewakWewak UrbanBurui-KunaiGawiNorth WoseraSouth WoseraEast YangoruNumborSaussoWest YangoruAlmamiIabuYawarAmbenobMadang UrbanTransgogolArabakaJosephstaalSimbaiKovonAstrolabe BayNaho RawaNayudoRai CoastKarkarSumgilbarBundiUsinoGamaMumengWariaWatutWau-Bulolo UrbanWauBuangHubeKotteFinschhafen UrbanYabim-MapeBurum-KwatMorobeSalamauaWamparDeyamosKomba (Seko)YusSelepetAhiLae UrbanOnga-WaffaUmi-AtzeraWantoat-LeronKapaoNanima KaribaKomeWapiLabutaNabakWain-ErapSialumSiassiWasuEast AitapeEast WapeiWest AitapeWest WapeiMawase (Nuku)PalmaiYangkokMaimai WanwanNameaOksapminTelefominYapsieAmanabBewani-Wutung-OneiGreen RiverVanimo UrbanWalsa12. Name of Ward, Village and Address

If no formal postal address or address is closed etc, can indicate private mailbag and the other addresses eg, name of village and wards number etc must be accurately provided. Thanks

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13. What are the expected results of this projectObjectives, time, cost, phases of the project, processes etc.14. What would be the estimated cost of the projectLess than K10,000K10,000-K20,000K20,00-K30,000K30,000-K40,000K40,000-K50,000K50,000-K60,000K60,000-K70,000K70,000-K80,000K80,000-K90,000K90,000-K100,000More than K100,00015. Key stakeholdersSelect only 5 top stakeholdersMakim 5 pla skills tasol :)HealthEducationAgricultureTourism & CultureEnvironmentForestryTransportFisheriesChurchesCommunity DevelopmentAustralian AID/DFATUSAIDNZAIDUNAIDSEuropean UnionOthers16. Who benefits from the project?Makim 5 pla talents tasol :)MenWomenYouthChildrenDisable/ElderlyOther Vulnerable Populations17. What are some risks involved in the project?FloodingLandslidesFood ShortageViolenceRobberyTribal WarfareLaw & Order IssuesLack of community SupportLack of Financial SupportOthers

18. How will you sustain the project after the volunteer exits?

Identify same skilled person in the communityIdentify potential young person and sponsor to receive appropriate skillsFind a permenant employeeOthers

Part C: ELIGIBILITY CRITERIA

1. Have you engaged an NVS volunteer in the past?

YesNo

2. Name of the volunteer3. Details of the work done by the volunteerWhat year and what were the achievement and challenges4. It is a requirement by NVS that the Partner Organization provide the volunteer with certain necessities, indicate your preparedness by selecting the items that are ready on siteNote that this will determine your eligibility for volunteer placement.HousingKitchen/Toilet FacilitiesPiece of land for gardeningSecurityManpowerContinous Support to Volunteer5. What type of volunteer do you require for your project?Type of volunteer must be in line with Part B. Project Eligibility. What Sector is the project likely to benefitCHWNutritionistFamily PlanningVillage Birth AttendantsVillage Health VolunteersHEONursing OfficerOthersElementary TeacherPrimary TeacherHigh School TeacherAdult LiteracyOthersCocoa FarmerCoffee FarmerVanilla FarmerPoluntryOthersCommunity PolicingMegistrateMediatorPolice PersonnelOthersSupport bring in touristsHospitalityTourist Events OrganiserOthersEnvironmental OfficerForestry OfficerDriverMechanicOthersFisheries OfficerPastorOutreach WorkerOthersCommunity Development OfficerOthers6. Provide the name of a nominated supervisor from within the host community

This person will play a supporting role to the volunteer as well as be responsible to oversee volunteer’s welfare. The nominated supervisor must be someone who is available and willing to support and assist the volunteer as and when the need arises.

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7. Contact number of nominated supervisor8. Nominated supervisor’s date of birth9. Take a photo of the nominee and upload

Make sure the preferred ID photos are attached: eg NID, Passport, drivers license or birth certificate. If none of this IDS, can attached a clear image with clear background without caps and eyeglass

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10. What is the highest qualification of your required volunteer?

DegreeDiplomaTrade CertificateTVET Certificate

11. What is your preferred language of communication?English, Pidgin, Motu

EnglishPidginMotuOthers

12. Terms of Reference for the volunteerBrief job description- 100 words

Part D: GENERAL

1. Indicate the basic services accessible from the project siteCan select more than one services applicableSchoolHealth CenterStoreBanking ServicesCommunication network (Digicel/Bmobile)Transport infrastructureOthers2. Indicate mode of transportation used to access the project location.Can select more than one transport systemsAircraftBoat/ DinghyPMV/ TruckWalking OnlyWalking and other transports3. Please indicate fares for transportationIe. Estimated total cost of getting from main provincial center to project siteLess than K10K10-K50K50-K100K100-K150K150-K200K200-K250K250-K300K300-K350K350-K400K450-K500K500 or more4. Tell us how you came to know about National Volunteer ServicesRadioNewspaperTelevisionBy Friends or WantoksBy NVS StaffInternetSocial Media (facebook, LinkedIn etcOthers

Part E: VERIFICATION

1. Name of the applicantPerson completing this form2. What is the applicant's position in the organisation?3. Signature

If using computer to fill the application, use the mouse to sign, if filling in from a fieldTask App or from smartphone, use your finger to sign your signature. To redo the signature again, tab the circle or refresh button to clear the signature and redo. Should you have any issues, call the NVS team on phone numbers: 7236 7128 or 7849 7586. Thank you :)

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4. Date5. Name of District Development Authority CEO6. Phone number7. Email Address8. Name of Provincial Administrator or Executive Officer9. Phone Number10. Email Address11. Name of Local Level Government Council President12. Phone Number13. Email Address14. Name of Ward Councilor15. Phone Number16. Email Address17. Record your location and saveIf you would like to record your location, click on the + sign to record your GPS location. Make sure you are in an open area and not in the building.18. Any other comments

Any comments, question or feedback you have for NVS can comment here or if you have any feedback on further improvement to this online application form, please state is clearly below. Thanks :)

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