ACCREDITATION APPLICATION FOR THE PARTICIPATION OF CIVIL SOCIETY IN THE
REGIONAL MEETING FOR THE INTERNATIONAL DECADE FOR PEOPLE OF AFRICAN
DESCENT
(Brasilia, Brazil, 3 – 4 December 2015)
PART I. TO BE SIGNED BY THE HEAD OF THE ORGANIZATION
I.
General information:
1.
Name of NGO:
2.
Address:
3.
Country:
4.
Phone number:
5.
Fax:
6.
Contact e-mail address:
7.
Website of NGO:
8.
Name of Head of organization:
9.
Year of establishment of the organization:
II.
Information on the selected NGO representative [it is mandatory to complete application with copy
of the representative’s national passport which will be used for travel purposes]:
1.
Name of representative:
2.
Date of birth:
3.
Gender:
4.
Email address:
5.
Phone number (office and mobile number if available):
III.
Information on the NGO:
1.
Status:
a. Does the NGO have ECOSOC consultative status?
Female

Male

Yes

No
b. Was your NGO accredited to the 2001 World Conference against Racism, Racial
Discrimination, Xenophobia and other Related Intolerance?
Yes

No

c. Was your NGO accredited to the Durban Review Conference?
Yes
2.
No

Does your organization represent people of African descent:
Yes
3.


No

If yes, is your organization working on:
- Women rights

- Youth issues

- Research

- Administration of justice

- Issues related to empowerment

- Economic, social and cultural rights 
- Other, specify
___________________________________________________________________________________
___________________________________________________________________________________
4.
Please provide information on activities your NGO has carried out since the World Conference Against
Racism (WCAR):
a. Kindly provide a brief list of your World Conference follow-up related activities:
__________________________________________________________________________________
__________________________________________________________________________________
b. On what recommendation(s) from the Durban Programme of Action has your organization
specifically followed-up?
__________________________________________________________________________________
__________________________________________________________________________________
c. Has your organization been engaged with the WCAR follow-up mechanisms and if so, how?
__________________________________________________________________________________
__________________________________________________________________________________
d. On what recommendation(s) from the Programme of Activities for the International Decade for
People of African descent is your organization specifically following-up?
__________________________________________________________________________________
__________________________________________________________________________________
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5.
Does your organization operate at the national and/or grass-root level:
__________________________________________________________________________________
I certify that the information provided in answer to the foregoing questions is true, complete and correct.
Enclosed is a photocopy of the passport of the NGO representative proposed to attend the meeting. I certify that
he/she is a member of the organization.
6.
Please indicate if your organization would like to applying for funding? Please note that OHCHR will
provide assistance to a limited number of selected civil society representatives, based on the criteria established
in Information Note N° 2 of 26 October 2015.
Yes

No

7.
Please indicate if you have any support requirements on the basis of disability
_________________________________________________________________________________________
Date: ________________
PART 2.
Signature of the Head of the Organization ___________________________
TO BE SIGNED BY THE PROPOSED NGO REPRESENTATIVE
The undersigned, ………………… representing the NGO………………, hereby undertakes to respect and
adhere to the United Nations principles, as well as established rules and procedures while participating in
meetings and activities in United Nations premises in the context of the International Decade for People of
African descent.
The undersigned also commits to undertake activities in full conformity with the letter and spirit of the Durban
Declaration and Programme of Action, and with the principles outlined in ECOSOC resolution 1996/31 on the
consultative relationship between the United Nations and non-governmental organizations.
Date: _____________________
Signature of the proposed NGO representative: __________________________
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