APPLICATION FOR UNESCO CLUB ACCREDITATION
Deadline: 31 July 2015
 For completion by the club head;
 Please email in PDF format to naucp@unescoclubsph.org
I. CLUB DETAILS
Name of club
Official date of
the
creation of the
club
Address
Telephone
Fax
Institution
No.
Street
Barangay
City /
Municipality
Province
Region
Postal Code
(Area code)
(Telephone)
(Area code)
(Telephone)
Email address
Website
Social media
of the club
Ex)The URL of the club on any social network, like Facebook
Club Category
(please put an
“X”)
___ Elementary / High School Club
___ College (or HEI) Club
___ Local Government Office
___ Business Council / Cooperatives / CSOs / NGOs
___ Others, please specify________________________________________
Program Sector
(please put an
“X”)
___ Education
___ Science & Technology
___ Social & Human Sciences
___ Culture
___ Information & Communication
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Members
No. of Male:
No. of Female:
Total:
Age Range of Members
Youngest:
Oldest:
Officers
Male:
Female:
Description of the club
(Club’s history, rationale, mission, vision, objectives and current interests should be included)
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II. ACCOMPLISHED ACTIVITIES AND PROJECTS
Date
Name of activities
that your club organized
within the last three years
Venue
Brief description with main
objective(s)
dd/ mm/ yy ~
dd/ mm/ yy
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III. CONTACT DETAILS
Club Adviser
(Surname)
Mr.
(Given Name)
(M.I.)
Ms.
Date of Birth
Club Designation
Mobile Number
Email Address
Facebook Account
Telephone Number
dd/mm/yy
Area Code
Year of Joining the Club
yyyy
Tel. No.
Club Head
(Surname)
Mr.
(Given Name)
(M.I.)
Ms.
Date of Birth
Club Designation
Mobile Number
Email Address
Facebook Account
Telephone Number
dd/mm/yy
Area Code
Year of Joining the Club
yyyy
Tel. No.
Other Key Officer
(Surname)
Mr.
(Given Name)
(M.I.)
Ms.
Date of Birth
Club Designation
Mobile Number
Email Address
Facebook Account
Telephone Number
dd/mm/yy
Area Code
Year of Joining the Club
yyyy
Tel. No.
IV. CLUB OFFICERS
Designation in
the club
Complete Name
FN, MI, LN
Mobile Number
Email Address
* Please include the Club Adviser/s.
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V. ORGANIZATIONAL STRUCTURE
Ex)
Club Head
Club vice-president
Auditor
Committee on
Community
Treasurer
Committee on
Academics & Research
Secretary
Committee on
Sports &
.
Recreation
.
.
.
.
.
.
.
.
.
.
.
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VI. INTENT/REASON FOR APPLICATION
1) When and how did you learn about UNESCO Clubs?
2) Why does your club wish to be a UNESCO Club?
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3) What kind of positive impacts do you expect to gain by joining UNESCO Clubs?
4) How do you think your club could contribute to UNESCO Clubs?
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VII. PLANNED PROJECT/ACTIVITY
UNESCO National Commission of the Philippines has five different sectors: Education, Science and
Technology, Social and Human Sciences, Culture, Information and Communication. Each of five sectors
works to achieve global visions of sustainable development encompassing observance of human rights,
mutual respect and the alleviation of poverty, all of which are at the heart of UNESCO’s mission and
activities. Ensure that these plans are aligned with the abovementioned overarching objectives of
UNESCO. Further information on five sectors can be found at www.unesco.gov.ph
For your reference, please see the UNESCO Calendar of events at http://goo.gl/TmOU41
What kind of activity does your club consider undertaking this coming year? Please indicate particular
sector that you wish to work with (Multiple choices are possible.)
____ Education
____ Social & Human Sciences
____ Information & Communication
_____ Science & Technology
_____ Culture
* Please use the same format below for each project/activity.
Planned Project/Activity
Name of activity
Rationale of activity
Brief description
Expected period/ date
of implementation
dd/ mm/ yy ~ dd/ mm/ yy
Target participants/
beneficiaries
Venue
Expected outcome
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Name of Club: ________________________________________________________________________
In my capacity as a Club Head, I undertake to ensure that my club organizes an activity related to
UNESCO themes at least once a year and sends a completed Annual Report to UNESCO National
Commission of the Philippines and National Association of UNESCO Clubs by 31st January of the
succeeding year. Failure to do so for two consecutive years will cause my club to be placed on the list of
inactive clubs.
_______________________________________
Signature of Club Head over printed name
________________
_______________________________________
Signature of Club Adviser over printed name
________________
Date (m/d/y)
Date (m/d/y)
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