Formulaire de demande de subvention pour la protection

ORGANISATIONAL INFORMATION

Organization Name*

Office Line*

Country*

Address*

Email*

Organisation’s mission or main focus of work and when it was formed.*

Contact Person Name*

Contact Person Title*

Endorsing Organisations

Funders that can endorse your work*

Email Address*

Phone*

Funders that can endorse your work*

Email Address*

Phone*

Funders that can endorse your work*

Email Address*

Phone*

Amount Of Request*

Full Amount in Words*

Detailed Budget*

Please state your area of activism. How long have you been active in this area?*

Provide a detailed description of the event that has led to your request. When did this event occur?

Provide a detailed description of the event that has led to your request. When did this event occur?*

Have you received support for this similar situation in the past?*

What measures have you already taken to protect yourself?*

Outline your immediate steps for protection once the funds have been received.*

Do you have plans after the 3-month period of this grant?*

What other support have you received and from whom?*