Project List Add
Please Note: In order to select more than one option for Organisation Type, Faith, etc. Please press and hold the Ctrl key while clicking.
Project Name	:
Project Sub Name or Acronym	:
Organisation Name, if different from project	:
Organisation/Project Type	:	N/A Business Church - Congregation Church - National Church - Regional Community Based Organisation Educational Faith Based Organisation Government National Government Regional Non Profit Organisation Private Welfare Organisation
If None of the above please fill in here	:
If faith based, please indicate	:	N/A Christian – Denominational Christian – Interdenominational Christian – Non denominational Jewish Muslim Other
If None of the above please fill in here	:
If from a specific denomination, please indicate	:	N/A Anglican Church Anglican Church of Southern Africa APK Kerk Apostolic Faith Mission (AGS) Baptist Union Church of England Church of the Nazerene Die Volle Evangelie Kerk Evangelical Lutheran Church Gereformeerde Kerk Lutheran Communion Methodist Church N. G. Kerk (Dutch Reformed) Nederduitsch Hervormde Kerk Reformed Church of Africa Rhema Bible Church Roman Catholic Seventh Day Adventist Swaziland Reformed Church United Congregational Church Uniting Presbyterian Church Uniting Reformed Church Wesleyan Church
If None of the above please fill in here	:
If from a specific denomination, give details of where your project fits into your Church structure.
District/Province/Sinode	:
Circuit/Diocese/Ring	:
Congregation/Parish/Gemeente	:
Focus, Aims and Objectives of project	:	N/A Advocacy Anti-retroviral therapy Awareness and Sensitization Behaviour Change Care & Support Care for Caregivers Community Care Counselling Education Food Support Funding and Fundraising Gender Issues Home-based Care Hospice Care Income Generation Projects Information and Materials Dissemination Labour Issues Legal & Policy Issues Mobilization Orphan Care Positive Living Prevention Prevention of Mother –to-Child Transfer Research Sexuality Education Training Treatment Youth Development
If None of the above please fill in here	:
Project Description Shortly describe in your own words what it is that you do	:
Affiliations Is your project or organisation affiliated to any other organisations, please mention them	:
Target Population Who is the primary beneficiaries of the project	:	N/A Activists Adults All Business and Employers Care Givers Children Christians Living with HIV/AIDS Church Leadership Communities Congregations Counsellors Disabled People Educators Elderly Employees Faith-Based Organisations Families Gays and Lesbians Healthcare professionals Homeless Persons Learners and students Men and Boys Mothers and Babies Mothers of children living with HIV/AIDS Orphans and other vulnerable children Parents Living with HIV/AIDS People Living with HIV/AIDS Pregnant women Prisoners Sex Workers Substance Abusers Terminally Ill Persons Women and Girls Youth
If None of the above please fill in here	:
How many people (of the target group) do you reach per month	:
How many Full Time (paid) Staff Members do you have	:
How many Part Time (paid) Staff Members do you have	:
How many casual or contract (paid) Staff Members do you have	:
How many volunteers are involved regularly	:
In which Region do you operate?	:	N/A Angola Botswana Kenya Lesotho Mozambique Namibia Other International South Africa - National South Africa; Eastern Cape South Africa; Free State South Africa; Gauteng South Africa; Kwazulu Natal South Africa; Limpopo South Africa; Mpumulanga South Africa; Northern Cape South Africa; Northwest Province South Africa; Western Cape Southern Africa Sudan Swaziland Uganda Zambia Zimbabwe
If None of the above please fill in here	:
In which Area do you operate?	:
In which Suburb do you operate?	:
In which City do you operate?	:	N/A Alberton Aliwal North Amanzimtoti Atteridgeville Baberton Beaufort West Belville Benoni Bethal Bethlehem Bisho Bishop Lavis Bloemfontein Bohlekong Boksburg Bothshebelo Brackenfell Brakpan Cape Town Carletonville Centurion De Aar Despatch Dundee Durban Durbanville East London Edendale KZN Edenvale Ermelo Estcourt Fort Beaufort Ga-Rankuwa George Germiston Glencoe Goodwood Graaf-Reinett Harrismith Heidelberg (Gauteng) Howick Isipingo Jeffreysbay Johannesburg Kempton Park Kimberley Klerksdorp Knysna Kroonstad Kwaguqa Kwa-Mashu Ladysmith Lephalale (Ellisras) Lichtenburg Mabopane Madadeni Mafikeng Mamelodi Mariannhill Mdantsane Mhluzi Middelburg Milnerton Mossel Bay Musina (Messina) Nelspruit Newcastle Nigel Nyanga Odendaalsrus Orkney Oudtshoorn Paarl Parow Parys Piet Retief Pietermaritzburg Pinetown Polokwane (Pietersburg) Port Elizabeth Potchefstroom Queensburg Queenstown Randburg Randfontein Robertson Roodepoort Rustenburg Sada Sandton Sasolburg Sebokeng Shallcross Simon`s Town Somerset East Somerset West Soshanquve Soweto Springbok Springs Standerton Stanger Stellenbosch Stilfontein Strand Temba Tembisa Thabong Thohoyandou Tongaat Tswane (Pretoria) Uitenhage Umlazi Upington Vanderbylpark Vereeniging Virginia Vryburg Vryheid Welkom Wellington Westonaria Westville Witbank Worchester Zwelitsa
If None of the above please fill in here	:
When was the project started	:
What is the expected duration	:	Short term - Less than 2 weeks Short term – less than six months Fixed term Ongoing
If applicable, when will the project end	:
Position of contact person	:
Position	:
If None of the above please fill in here	:
Organisation Phone	:
Organisation Fax	:
Organisation Cell	:
Organisation Email	:
Organisation URL	:
Organisation Postal Address	:
Organisation Physical Address	:
Contact Person details if different from above	:
Contact Person Phone	:
Contact Person Fax	:
Contact Person Cell	:
Contact Person Email	:
Contact Person Postal Address	:
How is the project funded	:	Private donors Organisation’s Members Corporate Sponsors Government National Funding Organisations International Funding Organisations Congregation/Church members
If None of the above please fill in here	:
Does the organisation make funds available to other projects or organisations?	:	YesNo
What resources do you have available to share with others? Resource Material developed by your organisation will be particularly valuable.(If we do not have this information, please fill in a Resource Questionnaire.)	:	N/A Care Givers Counsellors Food support Funds Other (please describe) Published Materials Training course
If None of the above please fill in here	:
What resource materials do your organisation use regularly, that you have found particularly helpful?	:	N/A Care Givers Counsellors Food support Funds Other (please describe) Published Materials Training course
If None of the above please fill in here	:
What are your project’s most urgent needs?	:	N/A Acces to Grants Counsellors Craft and Handwork Supplies Food Support Funds Other (please describe) Seeds and Garden Materials Sponsorship for Orphans Stipend for Volunteers Supplies for Home-based Carers Training Volunteers
If None of the above please fill in here	:
Is the organisation/project open to partnerships or co-operation with other organisations?	:
Is your organisation involved in any other HIV or AIDS related projects? If yes, please write down the names of the projects and fill in a separate questionnaire for each project.	:
Information Provided By? (please fill in your name)	:
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