HRDW-Entities Registration

Basic Information

Please complete this section so that we can communicate with each other.

Legal Name of Organization*

That will sign the Grant Agreement and accept responsibility for funds, if awarded):

Short bio*

Summarize your organizational interests, achievements, and ambitions.

Mailing Address

Country

Select

Name of Primary Contact

Title / Position

Email

Telephone

Secure Messenger APP

Select

App ID

Organization Profile

Please complete this section to provide general information about your organization

What is the organization legal situation?*

Incorporated

legally registered

Is your organization affiliated with any other organization?*

Affiliated

Not affiliated

Is your organization affiliated with any political entities?*

Yes

No

Please list the names of the members of the Board of Directors or Board of Trustees and their position titles (Chairman, Secretary, Treasurer, regular member, etc.)*

Please provide an organizational chart, if available

Drag and drop files here or

What is the size of your organization*

Number of employees / consultants / volunteers

Small < 50

Medium 50to 150

Large >150

Enter the beginning /ending date of your organization's fiscal (financial) year:*

Will your organization have support from funding sources, specifically for the project described in your proposal, during the period of the Hosting/Incubation, if it is awarded?*

Yes

No

Project Overview

Please answer the questions of this section carefully

Civic Space Issue to be Addressed (Background)*

Please describe the situation in details

Please summarize your project/initiative*

List your project objectives*

Objectives have to be measurable and time lined

Initiative Start Date*

Initiative End Date*

Describe any foreseeable risks that you are facing as/while implementing the Initiative/ project.*

And if applicable please also state the potential action/s to be taken if the threat/s occurs.

References

Please provide at least two independent reference persons who are familiar with your work.

Please provide reference 1 Contact details*

1a. Name:

1b. Organization:

1c. E-mail address:

1d. Phone number:

1e. Skype ID:

1f. Secure Messenger:

Please provide reference 2 Contact details*

2a. Name:

2b. Organization:

2c. E-mail address:

2d. Phone number:

2e. Skype ID:

2f. Secure Messenger:

Send me a copy of my responses