InterAction Membership Application
For both member and associate member applicants, your organization must complete the following application and submit the required supplemental materials to Kellie Peake at .
The supplemental materials include:
□A copy of your organization’s by-laws (or similar statement for an associate member)
□Articles of Incorporation(or similar statement for an associate member)
□IRS Letter of Tax Exempt Status (or similar statement for an associate member)
□Most recent Annual Report
□Most current Audited Financial Statement
□Most current 990 (or similar statement for an associate member)
□Three letters of recommendation fromthe CEO or President of an NGO, PVO or CSO, on their letterhead, InterAction members preferred
□A signed copy of InterAction’sStandards Review Form found here:(does not apply to organizations applying as an associate member)
For questions about the InterAction application process, contact Kellie Peake at
Last Update: April 2017
Section 1: Basic organization and contact information
Please check if you are applying as an InterAction Member or InterAction Associate Member
□InterAction Member – 501c3 registered in the U.S.
□InterAction Associate Member – International NGO
□InterAction Associate Member – University department
□InterAction Associate Member – Think Tank
□InterAction Associate Member – Other
Organization Name:
Organization HQ Address:
Organization HQ Telephone:
Organization website:
Year Founded:
Incorporated in the state of:
Statement of organizational purpose:
This may include your mission, vision, and/or strategic goals.
Briefly describe your organizations programs:
Include a listing of the location of field offices or regional offices worldwide
Name of CEO:
CEO Title:
CEO Email Address:
CEO Telephone:
Contact Person:
The contact person is the individual the InterAction Membership Team will communicate with regarding all application materials.
Contact Person Title:
Contact Person Email Address:
Contact Person Telephone:
Last Update: April 2017
Section 2: Interest in joining InterAction
Why does your organization wish to join InterAction? Please keep your response between 300-500 words.
How would your staff expect to participate?
Check all that apply. For more information about how InterAction works with our members, visit our website
Working Groups
Last Update: April 2017
□Communications Directors Working Group
□Disaster Risk Reduction (DRR) Working Group
□Evaluation and Program Effectiveness (EPE) Working Group
□Food Security and Agriculture (FS/Ag) Working Group
□Gender Based Violence (GBV) Working Group
□Global Health (GH)Working Group
□International Humanitarian Law (IHL) Working Group
□Sustainable Development Goals (SDG)Working Group
□Private Sector Working Group
□Protection Working Group
□Public Policy Committee (PPC)
□Refugee Policy Working Group
□Security Advisory Group (SAG) Working Group
□Shelter and Settlements Working Group
□Social Media Working Group
□Syria/Iraq Working Group
□Water, Sanitation and Hygiene (WASH) Working Group
□West Bank/Gaza Working Group
Last Update: April 2017
Shared Interest Groups
Last Update: April 2017
□Climate, Environment and Development
□Crisis/sudden onset (i.e. Hurricane Matthew)
□Disability
□Gifts-in-Kind
□Great Lakes
□Health-related emergencies (Ebola)
□Horn of Africa
□Lake Chad Basin
□Pakistan
□Prevention of Sexual Exploitation and Abuse (PSEA)
□Sudan/South Sudan
□Yemen
Last Update: April 2017
Initiatives
Last Update: April 2017
□G7/G20 Advocacy Alliance (U.S.)
□Results-Based Protection
□Narrative Project
□NGO Aid Map
□Democracy, Rights and Governance
□The Rockefeller Foundation’s Bellagio Center
□The Together Project
□NGO Futures
□Initiative for Open Ag Funding
□Young Professionals Network
Last Update: April 2017
Pledges
Last Update: April 2017
□NGO Global Food Security Pledge
□Humanitarian Action Pledge
□Global Nutrition Pledge
Partnerships
Last Update: April 2017
□Basic Education Coalition
Events
□Forum (attend)
□Forum (host a breakout session)
□Forum (sponsor)
□CEO Retreat
□Regional member meetings
How many staff members do you expect will participate in InterAction activities and who are they? Please provide contact information and/or anticipated roles or departments that will participate in InterAction activities
Last Update: April 2017
Section 3: Governance Standards and Employee Policies
Describe your governance structure in terms of the following.If you are applying as an associate member and do not have a board or governing body, please provide information on your governance and accountability structure.
□Independence of your board:
□Size of board and executive committee:
□Frequency of meetings:
□Does any member receive compensation for his/her work on the board?:
□Does the board approve your budget?:
Does your organization have the following written policies?
□Conflict of interest policy
□Whistleblower policy
□Document retention and destruction policy
Last Update: April 2017
Section 4: Partnerships
Do you work with partner organizations overseas? Please list three NGOS or CSOs with which your organization has worked in the last two years.
Please list the three organizations who are sending in a letter of recommendation on your behalf:
Last Update: April 2017
Section 5: Finances
Does your organization have any program(s) that focuses on the United StatesDomestic only; Domestic expense is defined as domestic (U.S.) activities that have no relationship to international activities, programs, or issues.)?: If so, what are the total expenses associated with your domestic work?:
Does your organization receive any gifts in kind?If so, what is the total monetary value of the gifts-in-kind expensed for the year as represented on your financial statements?:
Last Update: April 2017