Please Use This Form to Tell Us What Happened As a Result of Your Appeal

Report Back Form

Please use this form to tell us what happened as a result of your appeal

Date: ______Name: ______Position: ______Dioceses: ______Province: ______City: ______Country: ______Contact number: ______Email: ______

1. Please fill in the table below with information about the donations you received:

Donor Date Amount (Name of person, diocese, agency – if known)

2. How did you use the donations? Please fill in the table below

What did you do? Please specify Number of Total cost the items/material/resources on items/material/resources items/material/resources which you have spent the donations.

3. In addition to providing the items listed above, how else has the church helped the affected communities?

______

4. Who has benefited directly or indirectly from your emergency work? Please provide numbers

o Children ____

 Girls ___

 Boys ___

o Women_____

 Pregnant women ___  Nursing mothers___

 Widows___

o Men ____

o Elderly people ____

o People with disabilities ___

o Other____

5. How has the situation developed, and what is happening now?

______

6. Did you liaise with other partner organisations to respond to the emergency? If yes, which ones?

______

7. What were the main difficulties that you encountered?

a) ______

b) ______

c) ______

8. What have been your main achievements?

d) ______

e) ______

f) ______

9. What lessons have you learned can be used in other emergencies or by other churches?

______

10. If possible, please provide some testimonies from members of the community

2 ______

11. If possible, please send us some pictures to update the information on the website.

Thanks for taking the tine to fill in this report back form. We will make sure that there is a report on our website!