New Field Foundation

Organization Information Form

Please submit this form via email to

Please note, if your organization does not work in or have programs highly relevant to rural women’s organizationsin Senegal, Gambia, Sierra Leone, Liberia, Guinea, Burkina Faso, Mali or Côte d’Ivoire, your form will not be reviewed.

CONTACT INFORMATION

Organization
Organization name:
Previous organization name (if applicable):
Country:
Physical address:
Postal address (if different from above):
Website:
Preferred method of communication with us: / Post / Email / Phone / Fax / Other (please specify):
Date form completed:
Primary Contact
Name:
Title: / Gender: / ___Female ___Male
Phone number(s): / (office) (cell)
Email address(es):
Form Completed by (if different than primary contact)
Name:
Title: / Gender: / ___Female ___Male
Phone number(s): / (office) (cell)
Email address(es):

QUESTIONS

Please indicate your response by marking an X or providing a written answer to the following questions:

1)Is your organization a registered non-governmental organization (NGO) with the government of the country where it is based?

___ Yes

___ No. If no, please explain the organization’s legal status:

2)Does your organization work in any of the following countries: Senegal, Gambia, Guinea, Sierra Leone, Liberia, Burkina Faso, Maliand/orCôte d’Ivoire?

___ Yes. If yes, please specify which districts/counties/provinces within each country:

___ No. If no, please describe how your work is relevant to rural women living in the countries listed above:

3)Please provide a brief description of your organization's mission and major activities. What specific problems does your organization address?

4)Does your organization work with rural women and/or their organizations?

___ Yes

___ No. If no, please specify which populations your organization serves and describe how your work is relevant to rural women and/or their organizations:

5)Please provide financial information about your organization’s total income and expenditure for the previous financial year. Please also specify your local currency.

Total Income/Revenue / Total Expenditure / Currency
Last financial year

6)How did you hear about New Field?

Thank you for taking the time to inform us about your work.Please submit this form via email to

When you submit your information form, you will receive an automated response to acknowledge receipt. Given the high volume of organizations that contact New Field about funding opportunities, we cannot respond individually to each organization. New Field Foundation staff and/or program consultants will contact you to learn more about your organization only if funding opportunities are available that seem relevant to your areas of work.