MENA Regional Civil Society Knowledge Strengthening and Dialogue Meeting

CRG Strategic Initiative; MENA Regional Coordination and Communication Platform

ITPC-MENA

MENA Regional Civil Society Capacity Building and Dialogue Meeting

15-16 May 2017, Morocco

The following application is for participation in the meeting of civil society representatives from the Middle East and North Africa on 15-16 May 2017 in Morocco.

This application is open for individuals coming from all MENA countries that are eligible for the Global Fund.

Participants from countries applying for Global Fund grants for Window 4 (January 2018) are highly encouraged to apply (including Algeria, Egypt, Morocco, Mauritania and Tunisia).

All applicants are expected to submit full application, and must be able to attend for the whole two days of the workshop.

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* 1. A) Personal details

Name

Organizational affiliation

Position

Address

City/Town

Years involved with organization

Country

Email Address

Phone Number

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* 2. Languages spoken proficiently: (select one or more)

Arabic

Frensh

English

Other (please describe)

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* 3. Which best describes the type of organization you are primarily affiliated with, for the purpose of this application? (select one or more)

National or local non-governmental organization

International non-governmental organization

Community-based organization

Key population organization (MSM, Sex worker, transgender, People who use drugs)

Network of people living with HIV

Network of people affected by TB

Network of people affected by malaria

Other key population network

Other civil society organization (ie: Human rights, women)

Other (please describe):

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* 4. Which diseases does your organization work on? (select at least one)

HIV/AIDS

Tuberculosis

Malaria

Other (please describe):

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* 5. Which best describes your personal or organizational relationship with the Global Fund? (select only one)

CCM member

Principal recipient (PR)

Sub-recipient (SR)

Sub-sub-recipient (SSR)

Country dialogue participant

No formal relationship with Global Fund

Other (please describe):

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* 6. FOR CCM MEMBERS ONLY: What role do you or another representative of your organization play on the CCM? (select only one)

Member

Alternate

Chair or Vice-Chair

Technical advisor

CCM Secretariat

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* 7. Approximately how much of your work is focused on Global Fund, in one way or another? (select only one)

100%

More than half

About half

Less than half

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* 8. Has your organization taken part in the development of a concept note or “funding request” to the Global Fund since 2014? (Yes/No/I don’t know)

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* 9. Has your organization taken part in the development of the HIV national strategic plan of your country for the past years? (Yes/No/I don’t know)

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* 10. Do you expect your organization to take part in the development of a funding request to the Global Fund in 2017 or 2018? (Yes/No/I don’t know)

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* 11. Has your organization ever requested or received technical assistance through the Global Fund’s Community, Rights and Gender department?

Yes

I don’t know)

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* 12. If yes (Q11), please describe type:

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* 13. Has your organization ever requested or received technical assistance through another provider?

Yes

I don’t know)

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* 14. If yes (Q13), please indicate provider:

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* 15. Have your organization already been a sub recipient of Global Fund programs?

Yes

I don’t know)

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* 16. Is your organization planning to be a sub recipient to future funding request proposed to Global Fund ?

Yes

I don’t know)

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* 17. Why are you interested in participating in this regional meeting? (open response)

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* 18. What do you hope to get out of the meeting? (open response)

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* 19. Are you willing to develop and implement an action plan with other partners in your country as an outcome of participation in this meeting?

Yes

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* 20. Are you able to travel to Morocco with less than one month’s notice?

Yes

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* 21. What support would you need to obtain a visa for travel to Morocco? (select only one)

Letter of invitation and hotel booking

No support needed

Other (please describe):

Question Title

* 1. A) Personal details

Question Title

* 2. Languages spoken proficiently: (select one or more)

Question Title

* 3. Which best describes the type of organization you are primarily affiliated with, for the purpose of this application? (select one or more)

Question Title

* 4. Which diseases does your organization work on? (select at least one)

Question Title

* 5. Which best describes your personal or organizational relationship with the Global Fund? (select only one)

Question Title

* 6. FOR CCM MEMBERS ONLY: What role do you or another representative of your organization play on the CCM? (select only one)

Question Title

* 7. Approximately how much of your work is focused on Global Fund, in one way or another? (select only one)

Question Title

* 8. Has your organization taken part in the development of a concept note or “funding request” to the Global Fund since 2014? (Yes/No/I don’t know)

Question Title

* 9. Has your organization taken part in the development of the HIV national strategic plan of your country for the past years? (Yes/No/I don’t know)

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* 10. Do you expect your organization to take part in the development of a funding request to the Global Fund in 2017 or 2018? (Yes/No/I don’t know)

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* 11. Has your organization ever requested or received technical assistance through the Global Fund’s Community, Rights and Gender department?

Question Title

* 12. If yes (Q11), please describe type:

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* 13. Has your organization ever requested or received technical assistance through another provider?

Question Title

* 14. If yes (Q13), please indicate provider:

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* 15. Have your organization already been a sub recipient of Global Fund programs?

Question Title

* 16. Is your organization planning to be a sub recipient to future funding request proposed to Global Fund ?

Question Title

* 17. Why are you interested in participating in this regional meeting? (open response)

Question Title

* 18. What do you hope to get out of the meeting? (open response)

Question Title

* 19. Are you willing to develop and implement an action plan with other partners in your country as an outcome of participation in this meeting?

Question Title

* 20. Are you able to travel to Morocco with less than one month’s notice?

Question Title

* 21. What support would you need to obtain a visa for travel to Morocco? (select only one)

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* 22. Is there anything else you would like to be considered as part of your application to participate? (open response)