ESSLIP Participant Registration & Baseline Assessment Form

SECTION A: PERSONAL INFORMATION

Full Name *

Gender *

Date of Birth *

AGE *

Phone Number *

WhatsApp Number *

Email Address *

State/City of Residence *

Nationality *

LinkedIn Profile

Facebook Profile

Organization Website (if applicable)

Preferred Means of Communication

SECTION B: EDUCATIONAL BACKGROUND

Highest Educational Qualification *

Field of Study *

Languages Spoken *

SECTION C: ORGANIZATION PROFILE

Name of Organization

Year Founded

Registration Status

Registration Number

Street Address

Website

Vision Statement

Organizational Tagline

Describe your organization in not more than 50 words.0 / 50

SECTION D: ORGANIZATIONAL ELIGIBILITY

How many years has your organization existed? *

How many years have you been actively implementing projects? *

Which best describes your organization? *

SECTION E: FOCUS AREAS

Select all that apply. *

SECTION F: GEOGRAPHIC COVERAGE

Where do you currently work?

Region

Community

Local Government Area

State

National

International

SECTION G: BENEFICIARIES

Approximately how many people have you reached in the last 12 months? *

Who are your primary beneficiaries? *

SECTION H: ORGANIZATIONAL STRUCTURE

Number of Full-time Staff

Number of Part-time Staff

Number of Volunteers

Number of Board Members

Number of Advisory Board:

Number of Paid Consultants

Number of Interns

SECTION I: ORGANIZATIONAL CAPACITY ASSESSMENT

Rate your organization from 1–5.

Leadership *

Strategic Planning *

Decision Making *

Governance *

Team Leadership *

Vision *

Program Management *

Project Design *

Implementation *

Monitoring *

Evaluation *

Learning *

Financial Management *

Budegeting *

Accounting *

Fundraising *

Proposal Writing *

Donor Engagement *

Individual Giving *

Corporate Partnerships *

Grant Management *

Communications *

Branding *

Storytelling *

Social Media *

Website *

Public Relations *

Organizational Systems *

Policies *

HR Systems *

Procurement *

Risk Management *

Data Management *

SECTION J: CURRENT CHALLENGES

Select your top five challenges. *

Explain your biggest organizational challenge. *

SECTION K: TRAINING NEEDS ASSESSMENT

Rate your interest. (Scale: 1 - not interested; 5 - very interested)

Fundraising *

Proposal Writing *

Donor Compliance *

Theory of Change *

Monitoring & Evaluation *

Project Design *

Leadership *

Governance *

Financial Management *

Strategic Planning *

Advocacy *

Policy Engagement *

Communications *

AI for Nonprofits *

Digital Tools *

Impact Measurement *

Sustainability Planning *

Partnership Building *

Social Enterprise *

Resource Mobilization *

SECTION L: IMPACT BASELINE

Before this training... (Scale: 1 - not confident; 5 - very confident)

1. How confident are you in leading your organization? *

2. How confident are you writing grant proposals? *

3. How confident are you measuring impact? *

4. How confident are you developing strategic plans? *

5. How confident are you pitching to donors? *

6. How confident are you managing teams? *

7. How confident are you preparing organizational budgets? *

8. How confident are you communicating impact? *

SECTION M: ORGANIZATIONAL PERFORMANCE (BASELINE)

Provide current figures.

Annual Budget: *

Annual Income *

Number of Active Projects *

Number of Beneficiaries Last Year *

Number of Partnerships *

Number of Grants Won *

Number of Proposals Submitted *

Number of Policies Developed *

Number of Communities Served *

SECTION N: DIGITAL READINESS

Which tools do you currently use? (Rate your digital skill 1 - 5; 1 - poor , 5 - excellent)

Microsoft Office *

Google Workspace *

Canva *

ChatGPT *

Trello *

Asana *

Monday.com *

Slack *

Zoom *

Airtable *

Google Drive *

CRM *

KoboToolbox *

ODK *

SurveyCTO *

Power Bi *

SECTION O: EXPECTATIONS

1. Why do you want to join ESSLIP? *0 / 100

2. What specific problem do you hope the training will solve? *0 / 100

3. What will success look like after six months? *0 / 100

SECTION P: COMMITMENT

I commit to:

I Agree: *

commit

Attend all training sessions.

Complete all assignments.

Participate in mentoring sessions.

Participate in pre- and post-training assessments.

Submit follow-up impact reports after 3, 6, and 12 months.

Permit the Center for Development Practice to use my responses for
programme monitoring, evaluation, and learning while maintaining
confidentiality.

SECTION Q: MONITORING, EVALUATION & LEARNING (MEL) CONSENT

Yes *

I consent to:

Baseline assessment.

Endline assessment.

Follow-up surveys.

Interviews.

Focus Group Discussions.

Success story documentation.

Photography and video during programme activities.

Do you want to be certified? (Certification fee is $20.) *Please note: only certified participants are eligible for community membership and grant consideration.YesNo