YOUR ORGANIZATION DETAILS

PLEASE MAKE SURE YOUR RESPONSE TO REQUIRED FIELDS ARE 100% ACCURATE

* Required

Your Organization's Name *

Please enter name as stated on your legal documents

Other Popular Name of the Organization

If applicable, enter name by which your organization is popularly known, but different from its legally registered name

Enter your organization legal Liberian registration number

If your organization is not legally registered in Liberia, enter 10-1000.

Organization US 501c3 Tax ID number (or any registered ID #) *

If your organization has not received its legal registration number in any country other than Liberia, enter 12-312017

Organization's website address?

Organization's Address *

Please enter full mailing address, each line separated by comma

City*

Enter the City, District, County

State or Country *

Enter the country, if your corporate address is not in the USA

Zip Code

Describe your Organization and its work *

Please describe in less than 500 characters, in clear sentences, the social challenge you are addressing, the community you serve (who & where), how, and the difference you are making

CONTACT PERSON DETAILS

SOME TIME WE GET EMAIL IDS AND PHONE NUMBERS THAT ARE OUTDATED OR INCORRECT. PLEASE ENSURE THAT THE CONTACT PERSON INFORMATION IS ACCURATE AND THAT HE/SHE CHECKS EMAIL FREQUENTLY.

Contact Person's Name*

Contact Person's Email Address *

Contact Person's Phone Number (including area code)*

Make sure you include the area code and any extensions need to reach the contact person.

OTHER DETAILS

List the communities or locations where your organization provides services *

Please list the locations separated by commas.

Select the cause (s) that closely relates to your organization's work *

You may select multiple causes. Your choices might be used to connect you to relevant partners or resources.

Physically/ Mentally ChallengedChildren, Women & Family WelfareCivic and AdvocacyCulture and ArtsEconomic, Social and Community DevelopmentEducationElderly CareEmergency and ReliefEnvironmentHealthLivelihoods and TrainingSportsYouth WelfareOther

Select the groups that are served by your organization *

If applicable, you may select multiple groups.

AdolescentsAdultsBlood DonorsChildren / YouthsChronically IllSex WorkersDisaster AffectedDisplaced PersonsElderlyEbola VictimsFactory WorkersFarmers / Farm LaborersGirlsHealthcare WorkersHIV+HomelessJuvenileLegal WorkersLGBTMedical PractionersMentally ChallengedOrphansPatientsPhysically ChallengedPrisonersRefugeesRural PoorHuman Rights ActivistsSportspersonsStreet ChildrenWomenYouthNGOs

If selected to become one of our partners, what role could you possibly play?*

Facilitate planning and strategy meetingsHelp develop partnership strategiesHelp plan annual event in LiberiaSeek and coordinate volunteersHelp Increase corporate partnershipsCoordinating and creating awareness for all partnersDocument partners' activitiesHost partners' eventsHelp manage social pagesUpdate this websiteHelp write monthly newsletterCreate budget for joint partnership events

SOCIAL MEDIA FOR IMPACT

If you want us to share your organization's posts to help highlight your organization's challenges or promote your events and accomplishment, please enter the full URL of your social media accounts (e.g. http://www.facebook.com/XYZ)

Organization's Facebook Profile Link

Organization's Twitter Profile Link

Organization's LinkedIn Profile Link

Organization's Instagram Profile Link

How did you hear about #GivingTuesdayLiberia?*

From another partnerFrom direct emailFrom direct phone callFrom YesLibireaFrom GivingTuesday GlobalFrom FacebookFrom TwitterFrom GoogleFrom LinkedInOther

Agreement *

GivingTuesdayLiberia is all about charitable support; giving and participation should not be used for any commercial purposes or promotion of any for-profit product or service.

We agree to the terms of participation.