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C o m m u n i t y D e v e l o p m e n t

SOCIAL RESPONSIBILITY APPLICATION

By completing the following application form, you certify that you are applying for a donation or involvement from EvaluNet for an outreach programme that you are affiliated with - e.g. children's care centre, orphanage, community development etc. The information you are providing us will be treated as highly confidential. * Required

Your Personal Details
Name:	*
Surname:	*
E-mail Address:	*
Telephone:	* (include dialing code)
Postal Address:	* (include postal code)
Company Name:

Organisation Details
Name:	*
Status:	* (school, NGO, NPO, etc.)
Physical Address:	*
Postal Address:
Telephone:	*
Facsimile:
Web Address:
E-mail Address:

The Team

Please tell us who works for the organisation - give us a brief description of the persons involved:

Donation/Involvement Details & Organisation Background
Does the organisation currently have a computer centre? *
Yes
No
If you answered "Yes" above, please tell us:
How many computers?
What operating system?
Please provide us with a brief description of your organisation, its main activities, what it hopes to achieve, and what it has already achieved:
*
Please tell us how EvaluNet can be involved in your organisation:
*
Please select one or more of the following that apply to your organisation: *
Focuses on assisting schoolchildren with schoolwork
Focuses on assessing schoolchildren's level of knowledge
Focuses on parents and their role played in their children's school career
Focuses on developing ITC skills amongst schoolchildren
Focuses on developing skills in other learning areas amongst schoolchildren
Other - please specify
Is your full proposal document available in electronic format?
Yes, it's available in electronic format upon request
No
Where did you hear about EvaluNet's Community Development? *

Kindly ensure that you have completed all the requested fields above and that the information you are providing us is correct, then click "Submit" below. The information you are providing us will be treated as highly confidential.