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Forum Membership Form
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Forum Membership Form
Impact Philanthropy Africa is a forum of self-funded corporate and private charitable foundations working across Africa to create social impact. Registered in Kenya, the aim of Impact Philanthropy Africa is to increase the societal impact of corporate and private giving in Africa, with a view to transforming lives by improving the social and economic status of communities in alignment with achieving the SDGs. Impact Philanthropy Africa members aim to build a culture of philanthropy in Africa and influence policy through advocacy and thought leadership.
SECTION 1: Contact Information
Each member organization should nominate and empower a suitably-qualified Senior Representative with a track record of engagement in organizational philanthropy. Member organizations should also nominate an Alternate Representative who would attend Forum meetings in the event the Representative is not available. Should a Representative and/or Alternate Representative transition out of any member organization, replacements should be appointed and their details communicated to the Forum secretariat.
Primary Focal Point
This is the representative with whom the Forum Secretariat will communicate on a regular basis as the primary point of contact.
Name
*
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Last
Job Title/ Role
*
Email
*
Work telephone
*
Mobile telephone
*
Secondary/Alternate Contact
Name
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Last
Job Title/ Role
Email
Phone
Add other Contact Details
Personal Assistant to primary focal point
CEO/ Executive Director's Contact info
Any other alternate contact
Select All
Personal Assistant to primary focal point
Name
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Last
Job Title/ Role
Email
Phone
CEO/ Executive Director's Contact info
Name
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Last
Job Title/ Role
Email
Phone
Any other alternate contact
Name
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Last
Job Title/ Role
Email
Phone
SECTION 2: Organization Details
Company Name
*
Which governance structure applies to your organization?
Registered as non-profit company (NPC)
Registered as a Trust
Registered as a Charitable Foundation/ Philanthropy
CSI department within the company
CSI responsibility within another department of the company (e.g marketing, communications, HR etc)
At which level does your Philanthropy/CSI programme operate?
*
Global level
Regional (Sub Sahara Africa)
National level
State the Country
Add
Remove
Which region do you operate in?
Central Africa
East Africa
Northern Africa
Southern Africa
Western Africa
SECTION 3: Organization Priorities
What are the development focus areas of your philanthropy work?
Education (support of programmes or infrastructure development at any level of education, from early childhood development, through tertiary and adult education)
Health (clinics, specialist care, wellness programs etc.)
Social and community development (beneficiaries include orphans and vulnerable children, feeding schemes, the elderly, homeless, prisoners and ex-prisoners, rural development, and other marginalised groups)
Food security and agriculture (food gardens, survivalist farming, etc) – note that feeding schemes are characterised as 'social and community development
Entrepreneur and small business support (training, mentorship, preferential terms and infrastructure for survivalist enterprises)
Environment (conservation, rehabilitation, recycling and awareness programmes)
Arts and culture
Sports development
Safety and security (community policing forums, safety campaigns)
Housing and living conditions (building houses, water and sanitation, energy and energy efficiency)
Disaster relief (supporting preparedness or relief, recovery, and/or rebuilding efforts in the wake of a natural or civil disaster or other emergency hardship situation)
Where would you say your organisation is on the sustainability journey?
1 is 'beginning our philanthropy journey' and 10 is 'A decade or more in philanthropy
1
2
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5
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10
What would you like to gain out of Impact Philanthropy Africa Forum?
How can Impact Philanthropy Africa help your philanthropy agenda?
If available, please upload a high resolution image of your organisation's logo
Max. file size: 60 MB.
Section 4: Advocacy for Change(A4C) Technical Working Group
One of Impact Philanthropy Africa’s strategic focus areas is Advocacy for Change. The forum aims to carry this out by strategically engaging Governments, and other key stakeholders on concerns pivotal to local philanthropy. You are encouraged to select your preferred committee based on your organisation's interest.
Select your preferred committee -:
*
Education committee
Health committee
Agriculture and Environmental Sustainability committee
Youth empowerment/Job creation and Entrepreneurship committee
Select All
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