Requests for Aid (Personal) Enter a financial aid request for a personal or individual project. To apply for financial aid for a startup, a microcredit for a company or a community project, use this form. Submit an Aid Request Form Defaults Create an account to enable saving this form Project Name * Your Name * Your Email * Your Role Project Country * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonarie(Antille Olandesi) Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Brazzaville Congo DR Cooks Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d‘Ivoire Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadalupe Guam Guatemala Guinea Guinea Conakry Guinea-Bissau Guyana - English Guyana - French Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinica Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caldonia New Zealand Nicaragua Niger Nigeria North Korea North Sudan Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Island Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis – Futuna Yemen Zambia Zimbabwe Lokálna komisia: Andina Zone Andina Zone Andina Zone Austria Baltic Countries Baltic Countries Baltic Countries Bangkok Bangkok Bangkok Bangkok Bangkok Belgium Belgium Brazil - 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Nordic Countries Holland - Nordic Countries Holland - Nordic Countries Holland - Nordic Countries Holland - Nordic Countries Holland - Nordic Countries Holland - Nordic Countries Hong Kong Hong Kong Hong Kong Hong Kong Hungary India India India India India India Indonesia Indonesia Indonesia Indonesia Ireland Italy Bologna Italy Bologna Italy Bologna Italy Bologna Italy Catania Italy Florence Italy Florence Italy Florence Italy Naples Italy North West Italy North West Italy Polo Lionello Italy Rome Italy Rome Italy Rome Italy Rome Italy Trent Italy Trent Japan Jerusalem Jerusalem Jordan Jordan Jordan Korea Korea Korea Lebanon Lebanon Lebanon Lebanon Lebanon Lebanon Lebanon Lebanon Madagascar Madagascar Madagascar Madagascar Maghreb Maghreb Maghreb Maghreb Manila Nigeria Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Oceania Pakistan Pakistan Poland Poland Portugal Russia Russia Russia Russia Russia Russia Russia Russia Russia Slovakia Slovakia Slovenia Slovenia South Eastern Europe South Eastern Europe South Eastern Europe South Eastern Europe South Eastern Europe South Eastern Europe South Eastern Europe Southern Africa Southern Africa Southern Africa Southern Africa Southern Africa Southern Africa Southern Africa Southern Africa Southern Africa Southern Africa Southern Africa Southern Cone Southern Cone Southern Cone Southern Cone Spain Spain Spain Switzerland Switzerland TBD TBD Turkey Turkey Turkey Turkey United States United States United States United States United States United States United States United States West Africa West Africa West Africa West Africa West Africa West Africa West Africa West Africa West Africa West Africa West Africa West Africa West Africa West Africa West Africa Choose the local currency * Austrálsky dolár (AUD) Brazilian Real (BRL) Canadian Dollar (CAD) Chinese Yuan Renminbi (CNY) Czech Koruna (CZK) Danish Krone (DKK) Euro (EUR) Hong Kong Dollar (HKD) Hungarian Forint (HUF) Indian Rupee (INR) Israeli New Sheqel (ILS) Japanese Yen (JPY) Malagasy ariary (MGA) Malaysian Ringgit (MYR) Mexican Peso (MXN) New Zealand Dollar (NZD) Norwegian Krone (NOK) Philippine Peso (PHP) Polish Zloty (PLN) Pound Sterling (GBP) Russian Ruble (RUB) Singapore Dollar (SGD) Swedish Krona (SEK) Swiss Franc (CHF) Taiwan New Dollar (TWD) Thai Baht (THB) Turkish Lira (TRY) U.S. Dollar (USD) please submit your financial information in the local currency Form mode You are editing in REPORT mode. Reporting sections are highlighted in this color. Personal 1) Recipient Data Date of First Request to EoC Recipient Name Recipient Email Recipient City and State Family Single Married Separated Widow Number of Dependent Children Number of Other Dependents Total Family Members * Level of Education None Hlavný Ďalší Higher Education (university) Employment 2) Employment and Family Income Family Income # Family members with an income Family monthly income * local currency Other sources of income please describe Jobs Please add a job status for all family members of working age. Click "Add" only if you need to enter a 2nd, 3rd and so on, worker. Person * Primary recipient Family member Type of Job (s) * Permanent full time job Permanent part time job Temporary job Irregular job Domestic job Unemployed Retired Student Please describe Add another job entry Remove the last job entry Difficulties 3) Difficulties Faced Is the EoC financial help expected to have a direct effect? Direct: The help directly contributes to solve the problem Indirect: The help covers some expenses while looking for major solutions to the problem Main Cause of Need (select all that apply) EoC help will be: Indirect Direct Unemployment or difficulty finding a job Indirect Direct Irregular or unpaid job Indirect Direct Debt Indirect Direct Health Problems Indirect Direct Housing Condition Indirect Direct Family situation (widow, single parent, separated parents) Indirect Direct Lack of family support Indirect Direct Lack of social support (other than family) Indirect Direct Other IndirectIndirect DirectDirect Existence of other aid Other financial aid * Yes, the recipient is receiving other financial aid No, this would be the only source of financial aid Other source(s) of aid Focolare (please describe)Focolare (please describe) Other (public assistance, local church, etc.)Other (public assistance, local church, etc.) Please describe and explain why the EoC financial help is not enough Outcomes Type of Eoc Help & Cause of Need Problem Solved? If Yes, Role of EoC Help Yes Partial No Yes Partial No Unemployment / difficulty finding job Yes No Partially Helped Partially Helped Did Not Help Irregular or unpaid job Yes No Partially Helped Partially Helped Did Not Help Debt Yes No Partially Helped Partially Helped Did not help Health Problems Yes No Partially Helped Partially Helped Did not help Housing condition Yes No Partially Helped Partially Helped Did not help Family Situation Yes No Partially Helped Partially Helped Did not help Lack of family support Yes No Partially Helped Partially Helped Did not help Lack of social support Yes No Partially Helped Partially Helped Did not help Other as specified previously Yes No Partially Helped Partially Helped Did not help Projects 4) Personal Project Purposes of the Help In this section, you will add the specific OBJECTIVES OF THE AMOUNTS TO BE GIVEN and of the HELP RELATIONSHIP established. Objectives are concrete and verifiable, and contribute to the general implicit objective of solving (or mitigating) the need condition identified in the previous section. Show objective examples Show me some examples Situation 1 - Both parents were laid off and have little money to buy food for the family Economic security: to enable the family to maintain its level of food consumption after the layoff of both parents Relationships development: to give the children opportunities for sport and youth group activities Situation 2 - An accident injured a family member and the medical expenses are a burden Personal education, training, health: support for medical expenses after an accident Situation 3 - A flood damaged the workshop of a carpenter, leaving him with no tools to perform his work Economic Security: to enable the carpenter to start working again after a flood partially destroyed his workshop Situation 4 - The father of the family holds a job which does not provide enough income for his family Economic Security: to attend 3 years of a course for computer technicians Personal education, training, health: to allow acquisition of professional skills as computer technicians Economic Security Personal Education, training, health Relationships Development Actions In this section, add the CONCRETE ACTIONS needed to achieve the objectives, plus any complementary actions which can contribute to the effectiveness of the help or to solve the main poverty problem. Situation 1 - Both parents were laid off and have little money to buy food for the family Use of funds: covering the monthly expense for fruit and vegetables Non-financial or complementary: addressing the unemployed head of family to local employers Non-financial or complementary: to signal to the family youth groups active in their area Situation 2 - An accident injured a family member and the medical expenses are a burden Use of funds: paying one surgical intervention Situation 3 - A flood damaged the workshop of a carpenter, leaving him with no tools to perform his work Use of funds: buying building materials Non-financial or complementary: the carpenter and his brother make their labor available Situation 4 - The father of the family holds a job which does not provide enough income for his family Use of funds: covering 50% of course fee Non-financial or complementary: to be in contact with centres for employment (if not done by the school) or with EoC entrepreneurs in the IT field Type of Action Use of funds Non-financial (complementary or not related to financial support) Reciprocity / active participation Action Executed? Yes Nie Partial Alternatives Planned Add Remove Financial Request 5) Financial Request Request Category * Food Zdravie Housing Education Food * Lump-sum In-kind assistance OtherOther Health * Purchasing medicines Surgical intervention OtherOther Housing * Rental payment Mortgage Refurbishment OtherOther Education * Primary School Secondary School University Professional courses Enrollment Year * Totol Length of Cycle * Amount requested * local currency Suma odovzdaná local currency Amount student will contribute local currency Amount student contributed Total # of people that will be helped # people helped Length of Help All financial aid is intended to be temporary. At the end of the year, specific motivations for continuing the financial aid in the following year will need to be provided. Expected Length * Temporary (problems faced are temporary/cause by recent destabilizing events) Permanent (problems are chronic) Expected end date Is this need is still present that the recipient is requesting another year? Yes No Choosing yes will duplicate the need request and you will be redirected to make any changes for the next year. Actual End Date Reason for continuing Outcomes 6) Immaterial Outcomes This section will be filled out with the help of an EoC commission member. Active Involvement 0 - No contribution 1 - Financial contribution on the side of the receiver 2 - Other contribution (work, knowledge, successfully passing school year, etc.) 3 - Financial contribution AND other contribution Reciprocity 0 - absence of reciprocity actions 1 - restitution or renounce to the help 2 - part of the help given to others in need 3 - non-monetary help to other people 4 - participation in community life 5 - creation of job opportunities for other people Trust Score (highest is 4) 0 - no trust 1 - low trust 2 - some trust 3 - moderate trust 4 - high level of trust shown by the receiver of the help Comments / Notes Acceptance * I accept the privacy policy and terms of use of Economy of Communion Business Network (required) reCAPTCHA
