DFI Associate - Application Form (Updated 2015)

Download this file here »

(Note: (1) Please read the ‘Notes for DFI Associates’ document

(2) There are three sections to this form: Section A is for organisations only; Section B is for Individuals only and; Section C questions 1-3 are to be filled out by all applicants, questions 4 and 5 are for organisations only. DFI Staff members will be happy to assist with the application process)

 

Section A: Organisations

(If you are applying as an individual please go to section B)

 

A.1)     Name of Organisation: _______________________________________

 

A.2)     Address:                         _______________________________________

            ________________________________________

          _________________________________________

A.3)    

Organisation Details

Contact Person Details

Phone Number: ________________

Name: ________________

Fax: ________________

Position in Organisation: ___________

Email: ________________

Phone (Landline): ________________

Website: ________________

Phone (Mobile): ________________

 

Email: ________________

 

A.4)     Status: (please tick where appropriate)

 

Voluntary                      Statutory                    Private / For Profit

 

Other:        

 

  • Phone (Landline): _____________________
  • Phone (Mobile):  ______________________
  • Fax: ________________________________
  • Email:  ______________________________

 

Section C:

  1. to be completed by all applicants, 4-5 to be completed by organisations only)

 

C.1)     Please set out briefly the reasons for seeking to become a DFI Associate:

C.2)     How do you consider that you can assist the work of DFI:

C.3)     How do you consider that DFI can support you: 

 

For Organisations Only:

 

C.4)     Primary business / activity areas of the organisation:

 

C.5)     Does your organisation have any current involvement or engagement relating to disability?

Yes                                         No

 

If yes, please outline:

 

Please enclose copies of:

 

  • Annual Report for latest year available and or any other documentation that describes the work of the organisation.

 

On receipt of the application further information may be sought.

 

I have read the attached ‘Notes for applicants to become DFI Associates – Terms and Conditions’ and I confirm on behalf of the organisation / as an individual named in the attached application form that the organisation/person is seeking to become a DFI Associate in keeping with the terms and conditions and is willing to abide by the obligations as set out, or as amended from time to time.

 

 

Signed: ______________________________

On behalf of [organisation name]: _________________________

Date: _________________

 

Completed application form and supporting documentation to be returned to:

 

Disability Federation of Ireland,

Fumbally Court,

Fumbally Lane,

Dublin 8

click to open/close

DFI Extranet

click to open/close

DFI & Member Upcoming Events

May 2017 Events
MoTuWeThFrSaSu
1234567
891011121314
15161718192021
22232425262728
293031