Emergency support - individual

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Attention! For security reasons and to prevent data leakage, you will not be able to save the form and continue filling it out later. Therefore, we advise you to first make a draft of the application in Word format and then copy/paste the content to the online form.

General information about the applicant

First name and last name as in passport:

Preferred name (if different from passport name):

Preferred pronoun:

Sex/gender

Are you submitting an individual or group application?

A collective application means that you are applying for support for yourself and your partner, family member, etc.

Did you move to another country or intend to do this? Why?

Email (we highly recommend using Proton email address):

Phone number for Signal:

For security reasons, we ask you to provide your Proton email address and the phone number where you can be reached on Signal. If you do not use these services, please register, as further communication will be carried out through them. If by any case you find difficulties to use them as normal, they are accessible when using a VPN. When using Signal, make sure that your privacy settings indicate that you can be found by your phone number

Field(s) of activity (women's rights, human rights, ecology, journalism, etc.):

Field(s) of activity (women's rights, human rights, ecology, journalism, etc.):
Field(s) of activity (women's rights, human rights, ecology, journalism, etc.):

Name of organization/initiative group (if applicable)

The region in which you operate

How long have you been working for this organization?

How long have you been involved in civic activism?

Briefly describe your activism experience:

Who can recommend you (full name, position, contact details of at least two people)?

Who can recommend you (full name, position, contact details of at least two people)?
Who can recommend you (full name, position, contact details of at least two people)?
Who can recommend you (full name, position, contact details of at least two people)?

How did you find out about the possibility of submitting an application to us?

Would you be comfortable communicating with us in English?

Yes

Your emergency situation and current difficulties

Please describe the urgency of your current situation and explain how it is connected to your work, activities, or the political context.
Please describe the current and ongoing difficulties you (and your family members, in the case of a collective application) are facing in connection with the above circumstances.
Describe the concrete results you intend to achieve during the support period.

Budget

All expenses must be stated in euros.
1-10 lines

Budget details

Description	Type of unit	Unit cost (€)	Number of units	Total cost (€)
Description	Type of unit Type of unit Enter other…	Unit cost (€)	Number of units	Total cost (€)
Description	Type of unit Type of unit Enter other…	Unit cost (€)	Number of units	Total cost (€)
Description	Type of unit Type of unit Enter other…	Unit cost (€)	Number of units	Total cost (€)
Description	Type of unit Type of unit Enter other…	Unit cost (€)	Number of units	Total cost (€)
Description	Type of unit Type of unit Enter other…	Unit cost (€)	Number of units	Total cost (€)

more lines

Grand Total:

No more than €3,000 for individual applications and no more than €5,000 for collective applications.

Duration of emergency support (in months, maximum 6):

If you have comments or additional clarifications on the budget, please provide them here.

The project team will do everything possible to maintain the security and confidentiality of the information received.

Once you submit your application, you will lose access to the information you have submitted. If you wish to save your application for personal use, please click “Preview” and print the web page; then click “Submit” to send your application.

Please note: for security reasons, you will not receive any confirmation by email.

We will contact you within 3 weeks of submitting your application.