Field Partner

wo Way Out’s eyes, hands, ears and strength are the in-country local organizations serving the needs of our target clientele. These Frontline partners target, screen, together with the poor design and provide need-tailored products and services using CRESS model. We are looking for partners. Please contact us for possible collaboration opportunities.

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Personal Information

First Name:

Last Name:

Job Title:

Telephone Number

E-mail:

Institution Information

Name of Organization:

Primary Address:

Mailing Address if Different from Primary Address:

What is the primary country in which you are planning to use Two Way Out funds?:

If applicable list other countries where you work:

Registration and legal status:

Organization Legal Status

Date your Organization was Founded

Date your Organization began Operation

Is your organization owned by shareholders?

Yes No

If yes, list the full names of all the shareholders:

Organization Mission and Activities:

Description of the mission of your organization

Description of the activities of your organization

Who is your primary target population and why do you target them?

What is the primary problem your organization is trying to solve?

What other organizations do you work with?

Are you affiliated to any network or group?

Yes No

If yes, List Them:

Reference/Contact Information 1

first name

second name

email

url

Reference/Contact Information 2

First Name

Last Name

Phone

Email

URL

Reference/Contact Information 3

First Name

Last Name

Phone Number

E-mail

URL