REGISTRATION FORM

To be Completed by District Economic Empowerment Coordinator

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* 1. Region Name

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* 2. Name of District

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* 3. Name of Reporting Officer at LGA level

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* 4. Headquarter Town

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* 5. Mandated Area of Operation

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* 6. Name of Actor/Stakeholder

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* 7. Type of Actor/Stakeholder

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* 8. Contact Person

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* 9. Position

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* 10. Physical Address (post office)

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* 11. Telephone

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* 12. Email

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* 13. Website

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* 14. Year Registered

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* 15. Registration Category

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* 16. Origin

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* 18. Number of Districts being served

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* 19. Number of Clients served per Year in 2017

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* 20. Main Challenges faced by the Actors to be filled by the District Empowerment Coordinator. Use the following Codes for Challenges faced by Actors:

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* 21. Other Challenges

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