OGS Preferred Partners Application Home » OGS Preferred Partners Application Preferred Partners Application Form Section 1: Organization OverviewOrganization's Legal Name:(Required)Year Established:(Required)Input numerals onlyMission Statement:(Required)Primary Geographic Focus:(Required)Contact Person's Name:(Required)Contact Person's Name Title: (ie - Mr., Mrs, Ms., Dr., etc)(Required)Contact Person's Job Title:(Required)Contact Person's Email Address:(Required) Contact Person's Phone Number:(Required)Are you authorized to sign legal documents on behalf of the organization?(Required) Yes No If you answered 'No' above, provide the name, job title, name title (ie Mr., Mrs., Dr., etc), email address, and phone number for a person who is authorized to sign legal documents on behalf of the organization.Organization's Website Address:(Required)Organization's Mailing Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country List links to the organization's social media accounts:(Required)Section 2: Alignment with OGS MissionDescribe how your organization’s mission and programs align with OGS’s goal of preventing blindness and vision impairment.(Required)Provide examples of optometry-led programs your organization has implemented.(Required)Section 3: Program ImpactDescribe 2-3 programs your organization has implemented in the past 5 years. INCLUDE: Objectives; Target Population; Outcomes & Impact Metrics.(Required) Share any external evaluations or reports that demonstrate your programs' effectiveness.(Required)Section 4: Future ProgramsDescribe your organization’s programmatic for the next 3 years. INCLUDE: Clear objectives and measurable outcomes; Strategies for scalability and sustainability; A timeline for implementation and key milestones; Budget(Required)Section 5: Scalability and SustainabilityExplain how your organization ensures the scalability and sustainability of its programs.(Required)Provide examples of programs that have been successfully scaled or replicated.(Required)Section 6: Financial Stability and AccountabilityProvide your organization’s most recent audited financial statements.(Required)Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 64 MB.Describe your organization’s oversight practices.(Required)Section 7: Additional InformationProvide any additional information that supports your application as a Preferred Partner.
