The Initiative For Equal Rights
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Menu
Home
Who We Are
About Us
Our Partners
What We Do
What You Can Do
Resources
Q Convos Podcast
Resources & Reports
Violation Report Form
Services
Mental Health Therapy
Book A Doctor’s Appointment
Emergency Fund
Self-Test Kit Eligibility Form
News
Blog
Recent News
Contact Us
Menu
Home
Who We Are
About Us
Our Partners
What We Do
What You Can Do
Resources
Q Convos Podcast
Resources & Reports
Violation Report Form
Services
Mental Health Therapy
Book A Doctor’s Appointment
Emergency Fund
Self-Test Kit Eligibility Form
News
Blog
Recent News
Contact Us
Organisation
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Applicant Details
Tell us about yourself
Organisation Name
*
Office Address
*
Contact Person Name (Please provide the name of an employee we can contact directly about this request)
*
First
Last
Contact Person Phone (Please provide the phone number of an employee we can contact directly about this request)
*
Contact Person Email (Please provide the email address of an employee we can contact directly about this request)
*
Fund Request Details
Tell us what you need the requested funds for
Organisation Background Information (Please provide us with detailed information about your organisation and the work you do. Provide links where necessary)
*
What are you requesting emergency funds for? Tick all that apply
*
Legal Representation - You need funds for legal representation for a community member
Medical Support - You need funds for medical support including hospitalisation and drugs for a community member
Other
If you ticked other above, please enter your response here
How much do you need? (Write an exact amount of Naira in words)
*
Request Justification (Please provide information on why you need this support and any justification that can help the Application Review Board understand your request, including the name, phone number and other details of the beneficiary where possible)
*
Provide as much detailed information as you can in not more than 800 words. If you are requesting for multiple reasons (e.g. Legal and Medical Support), make sure your justification covers all.
References
Please provide the contact details of two persons who can confirm your organisation's work
Reference 1 - Name of Referee
*
Reference 1 - Email Address of Referee
*
Reference 1 - Phone Number of Referee
*
Reference 1 - What is the referee's relationship with the organisation?
*
Reference 2 - Name of Referee
*
Reference 2 - Email Address of Referee
*
Reference 2 - Phone Number of Referee
*
Reference 2 - What is the referee's relationship with the organisation?
*
Supporting Documents
Please provide documents that can support your request and provide legitimacy to your claims. For example, company registration documents, staff ID card, pictures of the event, medical bill/invoice or prescription, travel invoice. Only upload documents that are relevant to your request.
Upload Supporting Documents
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You can upload up to 6 files.
Submit
