<p> Livelihood mainstreaming Actors Information Sheet</p><p>After presentation of HI livelihood project, fill in this information sheet together with the identified actor</p><p>Name of your institution: ………………………………………………………………….. Acronyms: ………………………………...</p><p>Type of institution: - Ahcenese Non Governmental Organization □ - Indonesian Non Governmental Organization □ - International Non Governmental Organization □ - Governmental Agency □ - State Institution □ - Private Company □ - UN Organization □ - Other (please precise) ………………...……………………………………………</p><p>Department: …...…………………………………………………………………………… Address: …………………………………………………………………………………… ……………………………………………………………………………………………… Website: …………………………………………………………………………………… Main Contact Person: ……………………………………………………………………… Email: ……………………………………………………………………………………… Telephone: …………………………………………………………………………………. Fax: ………………………………………………………………………………………... Mobile phone: ……………………………………………………………………………...</p><p>Your activities related to Livelihood Support: Ending date (if necessary) - Psychological and/or social support □ ………………………</p><p>- Basic Soft skills trainings □ ………………………</p><p>- Small Business Management trainings □ ………………………</p><p>- Vocational Trainings □ ………………………</p><p>- Capital support □ ………………………</p><p>- Job placement □ ………………………</p><p>- Market Study □ ………………………</p><p>- Other (please precise) …………………………… ……………………… Do you focus on specific types of projects? - Agriculture □ - Aquaculture □ - Handicraft □ - Livestock □ - Small Business □ - No specific □</p><p>Do you have any specific targeted public? - Women □ - Tsunami affected people □ - Vulnerable people □ - No specific public □ - Other (please precise) ……………………………………………………………</p><p>Can you propose individual support or only group support? - Individual only □ - Group only □ - Both □</p><p>Do you have any limitations in Aceh geographical area? - Tsunami affected areas □ - Post conflict areas □ - Specific districts* (please precise)………………………………………………... ………………………………………………………………………………………</p><p>*Regarding more precisely the district of Aceh Besar: - The whole district of Aceh Besar □ - Indrapuri □ - Seulimeum □ - Sukamakmur □ - Mesjid Raya □ - Ingin Jaya □ - Darul Imarah □</p><p>Do you have any tools for selection process and accompaniment of beneficiaries?</p><p>Yes □ No □</p><p>Can you share it with us? (Enclosed to the document)</p><p>Yes □ No □ If you are providing capital support for livelihood project, could you precise if it is: For individuals or groups of people, limitation in amount, interest rate, other criteria, directly or through partner organization…?. Ending date (if necessary) - Cash grants □ ……………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… …………………………………………………………………………………………</p><p>- Assets recovery □ ……………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… …………………………………………………………………………………………</p><p>- Seed Capital □ ……………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… …………………………………………………………………………………………</p><p>- Revolving funds □ ……………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… …………………………………………………………………………………………</p><p>- Micro Credit □ ……………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… …………………………………………………………………………………………</p><p>Would you be interested in working in collaboration with us to include people with disabilities within your programs? Yes □ No □</p><p>Do you need some more information about what we are doing in the field of livelihood and potential collaboration? Yes □ No □</p><p>In which area do you think we could collaborate? Referral □ Sharing of information □ Identification of entrepreneurs (apprenticeship) □ Provide behavioral soft skills □ Identification of market opportunities □ Provide technical support □ Please give details on the activities you have mentioned above or any other activities of interest you would like to inform us about:</p><p>Met by:…………………………….. On:……………………………. In:…………………………………………………………………………………………...</p>