Language
English (Canada)
French (Canada)
Organization Information Form
Please complete this form as the next step in becoming a Delivery Partner with the Duke of Edinburgh's International Award - Canada. This form will be used to compile the necessary information needed for the agreement. Please note, this form should be filled out by a Senior Manager of your organization.
Preferred Language
*
English
French
Organization Name
*
Please use the legal name of your organization.
Organization Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Province/Territory - Please write the full name
Postal Code
Province/Territory
Please Select
British Columbia
Alberta
Yukon
Saskatchewan
Manitoba
Nunavut
Northwest Territories
Ontario
Québec
New Brunswick
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
Is your mailing address the same as the address above?
*
Yes
No
Mailing Address
Mailing Street Address
Mailing Street Address Line 2
Mailing City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Province/Territory - Please write the full name
Mailing Postal Code
Mailing Province/Territory
Please Select
British Columbia
Alberta
Yukon
Saskatchewan
Manitoba
Nunavut
Northwest Territories
Ontario
Québec
New Brunswick
Nova Scotia
Prince Edward Island
Newfoundland and Labrador
Additional Organization Information
Please indicate whether your organizations is a registered charity or non-profit organization
*
Yes
No
Business or Non-Profit Incorporation Number (not required if you're a government school)
*
Type of Organization
*
Please Select
Community Group or Organisation
Corporate Organisations
Government School
Independent School
Justice or Youth Justice
Open Award Centre
Private School
Religious Group
Sporting Club or Organisation
Uniformed Organisations
University
Voluntary Youth Group
Of your membership, how many young people are between the ages of 14 and 24?
*
Does your organization have the following policies and procedures in place? Please note, if you do not have these in place our team will be able to support you to develop them in order to meet the licence standards. Please check ALL that are in place at your organization:
*
Safeguarding and child protection policy
Serious incident reporting policy
Data protection policy
Human Resources policies for staff
Risk management policy
Public liability insurance
Worker’s compensation/Employer’s Liability Insurance
Any other insurance policies that are required/desirable in the jurisdiction
Contacts
List of contacts required for the Award. In order to proceed with an agreement, it is required to have the contact to which the invoices are directed, the name of two Signing Authorities, an Authorizing Contact, and an Award Coordinator.
Invoice Contact Name
First Name
Last Name
Invoice Contact Email
example@example.com
Signing Authority
A Signing Authority is an officer or agent of your organization with written authorization to commit the legal entity to a binding agreement. This person could be the same as the Agreement Holder.
Signing Authority #1 Name
First & Last Name
Signing Authority #1 Email
example@example.com
Signing Authority #2 Name
First & Last Name
Signing Authority #2 Email
example@example.com
Authorizing Contact - Agreement Holder
This person is the senior manager responsible for the Award Centre Agreement. This person has agreed the Award should be offered by your organization, has the power to sign the Agreement and holds the overall responsibility for ensuring adherence to the terms of the Agreement. This person can also be an Award Leader or an Award Coordinator. Typically, this might be a school principal or superintendent.
Authorizing Contact Name
*
First Name
Last Name
Authorizing Contact Role
*
Role of the Authorizing Contact in your organization.
Authorizing Contact Email
*
Please use an address which you check regularly. Ensure you have typed your email correctly.
Authorizing Contact Phone Number
*
Please enter a valid phone number.
Award Coordinator - Primary Contact
This person takes overall responsibility for the delivery of the Award within their organization. They coordinate with other Award volunteers, liaise with senior management, and work with the Award staff to ensure smooth operation of the Award in their organization.
Award Coordinator Name
*
First Name
Last Name
Award Coordinator Role
*
Role of the Award Coordinator in your organization.
Email Address
*
Email address of the Award Coordinator
Phone Number
*
Please enter a valid phone number.
I am aware of the requirements to become an Authorized Award Centre and I will provide all necessary documentation requested by the Duke of Edinburgh's International Award.
*
Yes
Please contact me
I am ready to enter into an Award Centre Agreement as the basis of the relationship between my organization and The Duke of Edinburgh's International Award.
*
Yes
Please contact me
I confirm that all the information given in this registration form is correct and accurate to the best of my knowledge.
*
I Agree
Completed by
*
Name of person who completed this form
Thank you so much for completing this form
You will receive an email shortly from Jotform Sign that includes the Agreement for your review. As a reminder, this needs to be signed by those individuals who have signing authority with your organization. The agreement outlines the relationship between The Duke of Edinburgh’s International Award - Canada and your organization as it pertains to delivering the Award.
PLEASE NOTE:
Jotform Sign agreements are emailed from Jotform Sign 'noreply@jotformsign.com'. Please ensure you and your signing authorities check your spam folders and add the 'jotformsign.com' domain to their safe list. Agreements will be sent out in one business day. Please contact your Award Staff if you do not see or receive your agreement within that time frame.
Account ID - HIDDEN {PLEASE PROCESS SUBMITTED FORM INTO ACCOUNT RECORD AND ADD TASK TO BUSINESS ACCOUNT MANAGER WITH TEXT: YOU HAVE A NEW AWARD CENTRE - THE ORGANIZATION INFORMATION FORM FOR [ACCOUNT NAME] HAS BEEN SUBMITTED. FOR THE QUESTION OF BEING AWARE OF AWARD REQUIREMENTS, ANSWER WAS: YES/PLEASE CONTACT ME. FOR READY TO ENTER INTO AN AGREEMENT, ANSWER WAS: YES/PLEASE CONTACT ME. IF NO BUSINESS ACCOUNT MANAGER ON ACCOUNT, ASSIGN TO KAREN}.
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