Partner Organization Information

Organization Name:

Website:

Address:

City/Country:

Phone Number:

Email Address:

Contact Person

Name:

Position/Title:

Email Address:

Phone Number:

Type of Partnership

Select all that apply:

Financial Support

In-kind Donations

Technical Assistance

Collaborative Projects

Capacity Building

Other (please specify):

Areas of Interest for Collaboration

Select all that apply:

Renewable Energy

Youth Empowerment

Women Empowerment

Health and Education

Environmental Sustainability

Other (please specify):

Brief Description of Partnership Proposal/Interest

Desired Impact of Partnership

Additional Information or Questions

Signature

Name:

Date:

I confirm that the information provided is accurate and agree to the terms.