Application

 

Established 501(c)3 small to medium sized non-profit organizations are encouraged to apply. Eligible organizations should submit the documents listed below. Only complete applications will be considered.

For proof of eligibility (copies are accepted): 

  • IRS Certificate of non-profit status
  • Articles of incorporation, by-laws and/or charter
  • Annual report with financial statement

For justification of the need for transportation funding (copies are accepted):

See Downloadable Application Forms below.

For proof of compliance (signed originals required):

  • Release from Liability 
  • Certificate of Compliance 
  • Certificate Regarding Expenses 
  • Consignment Affidavit

See Downloadable Compliance Forms below.

 

Downloadable Forms

IMPORTANT NOTE:Transportation Assistance Request form will not be considered if your organization does not have an Application Approval Notification from Counterpart International.

 Application Forms:

Last Updated

Size (KB)

Action Plan Proposal Form

8/10/2010

127K 

Compliance Forms

10/19/2006

50K 

Consignee Questionnaire (Eng)

10/19/2006

197K

Consignee Questionnaire (Rus)

10/19/2006

155K

 

Transportation Forms and Cargo Guidelines:

   

Transportation Assistance Request Form

10/19/2006

74K

Fumigation Statement

10/19/2006

34K

Fumigation Assistance Policy Application

10/19/2006

40K

Cargo Guidelines

8/10/2010

24K

Announcements

Current >

Flooding in Moldova and Western Ukraine:

Rains have caused serious damage to homes, infrastructure, electrical equipment and livestock throughout the area. The flooding has affected more than 236 villages and 77,000 people.
Learn how you can help.

Previous >

November, 2009
Zhytomyr, Ukraine

August, 2009: Tajikistan

Contact

Rang Hee Kim
Senior Director of CHAP

Mailing Address

Counterpart International, Inc.
2345 Crystal Drive
Suite 301
Arlington, Va 22202

Attn: Rang Hee Kim

P: 703.236.1200
F: 703.412.5035