Non-Governmental Organization (NGO) Unit

REGISTRATION FORM
FOR NON-GOVERNMENTAL ORGANIZATIONS’ DATABASE

Section 1. General Information

1. Organization category:

a. Non-Governmental Organization c. Faith Based Organization

b. Community Based Organization d. Other

2. Name of organization:
(If this is the umbrella /parent organization attach the listing of the membership.)

3. Name of parent organization: _______________________________________________

4. Address of organization: ___________________________________________________

________________________________________________________________________

5. Telephone number(s): (1): ________________ (2): ________________

6. Fax number: _________________ 7. E-mail: -____________________________

8. Website address: ___________________________________

9. Board Members Members of Committee

First Name Last name Position Phone #

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10. Date organization was established: ______ ______ ______
(Day / Month / Year)

11. (i) What is the registration status of the organization? (ii) Date of Registration:
(Day / Month / Year)

a. Incorporated by Act of Parliament _______ / ______ / ______

b. Incorporated under the Companies Ordinance ______ / _______ / ______

c. Registered under the Co-operatives Societies Act _______ / ______ / ______

d. Registered with a Ministry/Gov’t Agency (specify) _______ / ______ / ______

e. Registered with an umbrella NGO (see Q#3) _______ / ______ / ______

f. Not registered ________________________

12. Overall Goal of the organization:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

13. Geographic location of the organization:

Trinidad – Municipal Corporation

a. Arima g. Princes Town
b. Chaguanas h. San Fernando
c. Couva/tabaquite/Talparo i. San Juan/ Laventille

d. Diego Martin j. Sangre Grande

e. Mayaro/ Rio Claro k. Siparia
f. Penal/ Debe l. Tunapuna/ Piarco
g. Point Fortin
h. Port of Spain Tobago

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Selection II. Activities

14. Coverage of organization:

a. Service available to the immediate b. Service available to the national population

community
c. Service available to more than one
community, but not to the national
population

15. Organization’s beneficiaries:

Adolescent/ Teenage Mothers Primary Category Other Categories Applicable

(1 only)
a. Boys/ Men

b. Children

c. Community

d. Ex-Prisoners

e. Deportees

f. Girls/ Women

g. Older Persons

h. Persons Affected by Domestic

Violence

i. Persons Living with HIV/AIDS

j. Persons with Disabilities

Hearing Impaired

Visually Impaired

Intellectually Disabled

Physically Challenged

k. Persons/ Households Living in

Poverty
l. Prisoners

m. Single Parent Headed Households

n. Socially Displaced Persons

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 Adolescent/ Teenage Mothers Primary Category Other Categories Applicable
(1 only)
o. Substance Abusers

p. Unemployed

q. Youth

r. Other (Specify)

16. Approximate number of direct beneficiaries in the last year:

(i) Male _________ (ii) Female ________ (iii) Total ________

17. What services does the organization offer? (tick all that apply)

Adult Education Housing

Advocacy (specify) Infrastructural Development

Agriculture Legal Aid
Assistance in Emergencies/ Long Term Residential
Disasters
Business Development Marketing
Children’s Services Parenting Programmes
Communications Protection of the Environment
Community Development Prov. of Food Hampers/Meals

Conflict Recreational
Management/Mediation
Consulting Referrals
Counselling Security
Cultural Services for Older Persons

Drug Demand Reduction Services for Persons with Disabilities

Drug Rehabilitation Shelter (temporary)

Early Childhood Care and Small Business Development

Education
Employment Special Education
Family Life Education Spiritual Upliftment
Financial Aid HIV/AIDS Information
Foster Care Training
General Education Women’s Rights Services
Health Care Youth Development
Other (specify)
_____________

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18. Which other agencies/ organizations does the organization most frequently network with? (Please list up
to three agencies/ organizations below)

i) ___________________________________________________________________

ii) ___________________________________________________________________

iii) ___________________________________________________________________

18(b). Are you affiliated with or a subsidiary of any local and/ or foreign organizations?

Yes No

(If you answered yes, please list up to three agencies/ organizations below)

iv) __________________________________________________________________

v) __________________________________________________________________

vi) __________________________________________________________________

19. Resources/ Facilities available to the organization (tick all that apply)

(i) Own (ii) Have Access To

a. Books/Information Resources a. Books/Information
Resources
b. Multi-media b. Multi-media
c. Building(s) c. Building(s)
d. Computer Systems d. Computer Systems
e. Printers e. Printers
f. Photocopying Machine(s) f. Photocopying
Machine(s)
g. Other (specify) g. Other (specify

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20. Have any formal evaluations been conducted on the initiatives of your organization over the last three
years?

a. Yes b. No

21. What are the major challenges faced by your organization?

a. Funding h. Participation by
Members
b. Human Resources i. Co-operation/
Participation by
Beneficiaries
c. Appropriate Skills j.
d. Government Bureaucracy k. Supporting Network
e. Equipment l. Other
f. Facilities ____________________
____
Selection III. Organizational Structure

22. Does the organization have a constitution? a. Yes b. No

23. Does the organization have a strategic plan?

a. Yes b. No c. Don’t know

24. Which of the following administrative reports does the organization prepare?
(Tick all that applies)

a. Monthly Reports b. Annual Reports

c. Quarterly Reports d. Other (specify)
____________________

25. Please describe the organization’s record-keeping system(s):

a. Primarily computer-based b. Primarily manual \
c. Manual and computerized d. No record-keeping system (s)

26. Total number of members in the organization:

(i) Male _________ (ii) Female _______ (iii) Total ________

27. Please indicate the skills available to the organization:

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 No. of
No. of Paid Staff Volunteers/ Members
Type of Staff Full Part Full Part
Time Time Total Time Time Total
Professional/Technical
(specify area of expertise)
i.
ii.
iii.
iv.
Support
(specify category)

ii.
iii.
iv.

28. Has the organization been awarded or recognized for the service it provides?
Yes No

If yes, please specify __________________________________________________

Selection IV. Finances

29. Is there bank account in the name of the Organization?

a. Yes b. No

Account Number
______________________

Name on Account ______________________

Branch ______________________

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30. Are Income and Expenditure Statements prepared on an annual basis?

a. Yes b. No (If ‘No’, go to the end of the form)

31. i) Are your accounts audited?

a. Yes b. No c. Don’t know

ii) If ‘Yes’, please tick the applicable option below and specify person/firm:
a. Accounting firm _________________________

b. Private chartered _________________________

accountant
c. Experienced accountant _________________________

d. Other __________________________

31. Approximate percentage of funding received from the understated sources for the last financial year
(please complete all categories that apply):

Sources of Funding Approximate % of Funding Received

a. Government 0-20% 21-40% 41-60%
61-80% 81-100%
b. Corporate Sponsors 0-20% 21-40% 41-60%
(including local financial institutions) 61-80% 81-100%
c. International Institutions 0-20% 21-40% 41-60%
61-80% 81-100%
d. Private Individuals (members) 0-20% 21-40% 41-60%
61-80% 81-100%
e. Private Individuals (non-members) 0-20% 21-40% 41-60%
61-80% 81-100%
f. Fundraising Activities 20% 21-40% 41-60%
61-80% 81-100%
g. Other (specify) __________________ 0-20% 21-40% 41-60%
61-80% 81-100%

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32. i) Are fees charged for services?

a. Yes b. No

ii) If ‘Yes’, please specify the amount _____________________

End of Registration
Thank You for taking the time to provide this Information

OFFICIAL USE ONLY

Purpose for Initial funding: ___________________________________________
_________________________________________________________________

Coordinator NGO Unit:_____________________________________________

Date:

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