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Registering a Mutual Aid Group or a Partnering Organization - Sponsoring a Mutual Aid Group or a Mutual Aid Group Facilitator
Use this form to (1) register a Mutual Aid Group, or (2) a Partnering Organization, (3), to sponsor a Mutual Aid Group, and/or (4) a Mutual Aid Group facilitator
Name of the Communal Section
*
What do you want to do? (please check only one response)
*
Registering a mutual aid group
Registering a partnering organization
Sponsoring a mutual aid group
Sponsoring a mutual aid group facilitator
Registering a Mutual Aid Group; Name of the person registering the Mutual Aid Group
First Name
Last Name
Email of the person registering the mutual aid group
*
example@example.com
Phone Number of the person registering the mutual aid group
*
-
Area Code
Phone Number
Please tell us who you are, what kind of project your group wants to do, what do you hope to be the results of this project and why this work is needed in the communal section
*
How many members does your group have? Please select only one answer
*
5
7
9
Choose a priority area for the Mutual Aid Group
Choose a priority area
Crop production/Farm workers available
Fruit tree planting/Reforestation workers available
Livestock production/Livestock farmers available
Fishery aquaculture production/Farming workers
Access to clean water/Water well drilling
Flood Prevention/Retention and detention bassins
Cyclones resistant houses/Reinforcing houses
Cyclones resistant animal shelters/Animal shelters
Clean neighborhoods/Garbage collection - disposal
Improving home sanitation/Basic toilet facilities
Apprenticeship training/Learning a trade
Physical address of the location selected for holding regular Mutual Aid Group meetings
*
Street Address
Street Address Line 2
Department
Communal Section
Postal / Zip Code
Who are the owners of this location or the persons who authorized the use of this location for regular group meetings?
*
Rows
First Name
Last Name
Email
Phone Number
Person Number 1
Person Number 2
Person Number 3
Is the age of any of the member less than 15 or greater than 64?
*
Yes
No
Does any member of the group have a paid job?
*
Yes
No
Does each member of the group agree to
*
provide 20 hours of work each week
take 10 hours of training each week
keep looking actively for job
keep his or her children at school (if they have children)
practice the values of reciprocity, integrity, solidarity and respect
List the names, emails and phone numbers for the mutual aid group members. They must reside in the Communal Section. Residence in the Communal Section means that the mutual aid group members are literally living in the communal section: eating, sleeping and working and/or passing most of their time being physically there and they are not casual visitors or tourists.
*
Rows
First Name
Last Name
Email
Phone Number
Person Number 1
Person Number 2
Person Number 3
Person Number 4
Person Number 5
Person Number 6
Person Number 7
Person Number 8
Person Number 9
List the names, emails and phone numbers of 3 trustworthy persons (excluding the mutual aid group member) residing in the Communal Section who can testify that the mutual aid group members mentioned in the preceding question are indeed residents of the Communal Section. Residence in the Communal Section means that the individuals are literally living in the communal section: eating, sleeping and working and/or passing most of their time being physically there, and they are not casual visitors or tourists.
*
Rows
First Name
Last Name
Email
Phone Number
Person Number 1
Person Number 2
Person Number 3
Mutual Aid Group Facilitator Section: List the name, email and phone number for the Mutual Aid Group Facilitator you are sponsoring. They must reside in the Communal Section. Residence in the Communal Section means that a person is literally living in the communal section: eating, sleeping and working and/or passing most of his time being physically there and the person is not a casual visitor or tourist.
*
Rows
First Name
Last Name
Email
Phone Number
Person Number 1
List the names, emails and phone numbers of 3 trustworthy persons (excluding the mutual aid group facilitator) residing in the Communal Section who can testify that the Mutual Aid Group Facilitator mentioned in the preceding question is indeed a resident of the Communal Section. Residence in the Communal Section means that a person is living in the communal section: eating, sleeping and working and/or passing most of his time being physically there and the person is not a casual visitor or tourist.
*
Rows
First Name
Last Name
Email
Phone Number
Person Number 1
Person Number 2
Person Number 3
Does your sponsored mutual aid group facilitator live in the Communal Section?
*
Yes
No
Does your sponsored mutual aid group facilitator have a paid job?
*
Yes
No
Is the age of your sponsored mutual aid group facilitator less than 15 or greater than 64?
*
Yes
No
Does your sponsored mutual aid group facilitator agree to
*
provide 20 hours of work each week
take 10 hours of training each week
keep looking actively for job
keep his or her children at school (if they have children)
practice the values of reciprocity, integrity, solidarity and respect
UPLOAD A PHOTO OF YOUR MUTUAL AID GROUP FACILITATOR HOLDING A GOVERNMENT ISSUED PHOTO ID IN A VISIBLE MANNER (e.g., passport, driver’s license, national identification card)
*
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Partnering Organization Section: Name of partnering organization
Name of person filling this form
First Name
Last Name
Address of partnering organization
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email of person contact
example@example.com
Describe the business activity of the partnering organization
Provide a description of the skills the mutual aid group members will develop as a result of their assignment to work with the partnering organization. Please include also a timeframe for the development and mastering of those skills. Win-Win partnering relationships: Reciprocitas will provide to group members a monthly subsistence allowance while they are on assignment with the partnering organization, Mutual aid group members will raise and broaden their skills level and enable to contribute to your organization as if they were a full time employee.
Will the partnering organization hire as a full time employee at least one of the mutual aid group members at the end of their assignment?
Yes
No
Other
How many members of the mutual aid group will the partnering organization hire at the end of their assignment?
Submit
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