DFI Affiliate - Application form (Updated 2015)

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Voluntary Disabled Persons’ Organisation

 

 (Note: (1) Please read the “Notes for applicants to become DFI Affiliate Organisation" document

(2) DFI staff members will be happy to assist with the application process)

 

  1. Name of Organisation: _______________________________________

 

  1. Address:                        _______________________________________

________________________________________

________________________________________

3)        

Organisation Details

Contact Person Details

Phone Number: ________________

Name: ________________

Fax: ________________

Position in Organisation: ___________

Email: ________________

Phone (Landline): ________________

Website: ________________

Phone (Mobile): ________________

 

Email: ________________

 

  1. Status: (please tick where appropriate)

 

Limited Company                                Company Registration No. ____________

Date when first registered: ____________

     Unincorporated Organisation           

 

5) Charity Registration Number:  ______________

    Date when first registered:   ________________

 

6) Foundation Date: ___________

 

7) Names and Addresses of officers:

 

  • Chairperson:_______________________________________________

__________________________________________________________

  • Vice Chairperson:___________________________________________

__________________________________________________________

  • Honorary Secretary:_________________________________________

__________________________________________________________

  • Honorary Treasurer: ________________________________________

__________________________________________________________

  • Chief Executive / Director: ___________________________________

__________________________________________________________

  • Company Secretary(if Limited Company)_______________________

__________________________________________________________

 

8) Date of last Annual General Meeting: _________________________________

 

9) Paid Staff:

No. of staff ( if any )__________  Full Time ________  Part-Time _______

 

10) Volunteers (if any)____________ (Approx. numbers)

      Areas of activity ________________________________________________

 

11) Aims and Objectives:

 


12) Any recent Organisational Plans – Strategic, Operational, Service etc. produced. (Please give details)

 

13) Services and Supports undertaken:

 

  1. Direct services:

 

 

  1. Support services, i.e., information, advice, advocacy, representation etc. 

 

 

  1. Any other activities:  

 

 

 14) Member/Client Group(s) for which services/support are provided:

 

 

 

 

15)  Please set out briefly your reasons for seeking to become a DFI Affiliate Organisation: 

 

 

16) Is the applicant organisation a member of any other representative / support Organisations:       

 

                        Yes                    No 

 

If yes please give details

 

17) How do you consider that DFI may be of assistance to your Organisation:

 

18) Please set out briefly the main issues/challenges for your organisation at present:

 

19) Do you have a regular / occasional Newsletter or similar and if so Title:

 


Please enclose copies of:

 

  • Rules/Constitution or in the case of a Limited Company, Memorandum and Articles of Association.
  • Relevant Minutes of Board / Council /Committee recording the decision to apply for Affiliated Organisation status.
  • Audited accounts for latest year available.
  • Annual Report for latest year available.
  • Any other relevant material such as Organisational Plans / Strategies or Publications.
  • On receipt of the application further information may be sought.

 

I have read the attached “Notes for applicants to become a DFI Affiliate Organisation” and I confirm on behalf of the organisation named in the attached application form that the organisation is seeking membership in keeping with the terms of the Notes, and is willing to abide by the Affiliate Organisation obligations as set out, or as amended from time to time.

 

Signed: ______________________________

On behalf of: _________________________

Date:_________________

Completed application form and supporting documentation to be returned to:

Chief Executive Officer,
Disability Federation of Ireland,
Fumbally Court,
Fumbally Lane,
Dublin 8

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