Individual Support Form - ProtectDefenders % %

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1. CONTACT DETAILS
Full name*
Gender*
Name of the organisation, if any
Country of origin*
Country of residence*
Please indicate your preferred contact method. All communication will be kept confidential:
preferred contact method*
Phone number
E-mail address*
2. AREA OF WORK
Please insert a description (250 – 4000 characters) of your work as Human Rights Defender (please specify your area of work and what your work consists of).*
2. AREA OF WORK*
3. SECURITY AND RISKS
Please describe (250-8000 characters) the event that has prompted your application. Please include information about the type of threats, dates of the incidents and authors of the threats.*
3. SECURITY AND RISKS*
4. TYPE OF SUPPORT NEEDED (IF APPLICABLE)
(250-4000 characters) *
4. TYPE OF SUPPORT NEEDED*
5. SIMILAR APPLICATIONS SUBMITTED
Did you make similar applications to other possible donors, organisations or institutions? If yes, please specify who (please provide contact details) *
yes-no-SIMILAR APPLICATIONS SUBMITTED*
5. SIMILAR APPLICATIONS SUBMITTED*
Have you received any grant from other organisations for similar purposes in the last two years? If so, specify who, amount and costs covered. *
yes-no-received any grant*
5. received any grant*
6. CONFIDENTIALITY
should any specific information about the request be kept confidential? If so, ProtectDefenders.eu will not disclose individual names and contact information to any party outside of the organisation. *
Confidentiality*
This form is encrypted and its content is not shared with third parties. ProtectDefenders.eu will use your data exclusively to process your grant request.
Consent*
Please confirm you have read, understood, and agreed to the ProtectDefenders.eu privacy and data protection policy**
Consent*
I accept the processing of my data for the purposes of this request, in accordance with the privacy and data protection policy of ProtectDefenders.eu (without express validation to process your data, ProtectDefenders.eu will not be able to process the application)**

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