Clean Water

* indicates a required field.

This questionnaire is for orphanages joining the #H20Hope campaign, which focuses on providing children with clean water adaptation and practices of deploying efficient irrigation systems. Your responses will help us assess needs and prioritize resources. The program improves health, reduces disease, and fosters a safer environment for children’s growth and self-reliance by ensuring access to clean water.

FORM 6A

Pure Water, Healthy Lives

Step 1 of 2

1) ORPHANAGE INFORMATION:

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Head Master:

Children:

Facebook / Website page:

Email Address:

Years:

Telephone No:

CONTACT INFORMATION *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

3) COULD YOU SPECIFY EACH CHILD'S GRADE LEVEL AND CLASSIFICATION AS AN ORPHAN OR NON-ORPHAN?

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4) ORPHANAGE LEADERSHIP ON SITE?

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5) ENGLISH LANGUAGE SKILLS AMONG SITE LEADERS:

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The head orphanage/caretaker will initiate the form with the support of the Foundation's Orphanage Ambassador representatives (If Required)

6) DOES YOUR ORPHANAGE HAVE A RELIABLE AND ADEQUATE WATER SUPPLY SYSTEM?

7) DOES YOUR ORPHANAGE HAVE A DRINKING WATER STATION?

8) DOES YOUR ORPHANAGE HAVE ANY AGRICULTURAL OR GARDENING ACTIVITIES THAT REQUIRE IRRIGATION?

9) DOES YOUR ORPHANAGE FACE ANY CHALLENGES OR CONCERNS RELATED TO WATER SUPPLY OR IRRIGATION?

10) DOES YOUR ORPHANAGE HAVE QUALITY ISSUES WITH DRINKING AND IRRIGATION WATER?

11) DOES YOUR ORPHANAGE HAVE SPECIFIC CROP OR FOOD PRODUCTION GOALS THOUGH IMPROVED IRRIGATION?

12) ARE THERE ANY ENVIRONMENTAL REGULATIONS OR RESTRICTIONS ON GROUNDWATER USAGE IN YOUR AREA?

13) DOES YOUR ORPHANAGE HOME HAVE ANY EXISTING INFRASTRUCTURE THAT CAN BE UTILIZED FOR GROUNDWATER IRRIGATION TO SUPPORT SAFE DRINKING AND CROP PLANTING?

14) COULD THE NEIGHBORING COMMUNITIES OR ORGANIZATIONS BENEFIT FROM OR COLLABORATE ON THIS PROJECT?

15) IS YOUR ORPHANAGE COMMITTED TO PARTICIPATING IN CLEAN WATER INITIATIVES AND ENSURING LONG-TERM SUSTAINABILITY?

16) DOES YOUR ORPHANAGE HAVE A LONG-TERM SUSTAINABILITY AFTER THE IRRIGATION SYSTEM IS ESTABLISHED?

17) DOES YOUR ORPHANAGE HAVE ANY ADDITIONAL INFORMATION, OR MATERIALS TO SHARE REGARDING ITS INTEREST IN THE CLEAN WATER INITIATIVES PROGRAM?

18) DOES YOUR ORPHANAGE ALREADY PREPARED A PRIORITY LIST OF ITEMS NEEDED FOR EFFICIENT IRRIGRATION SYSTEM TO SUPPORT CLEAN WATER FOR SAFE DRINKING AND CROP PLANTING?

19) CAN YOU HELP COLLECT DATA AND PARTICIPATE IN EVALUATIONS TO ASSESS THE PROGRAM'S EFFECTIVENESS?

Does the orphanage have a photo collections of equipment lists or existing facilities to upload?

The information provided in the above Clean Water Program form is true and accurate. I accept the Terms and Conditions and Privacy Data Collection Policy. I agree that the relevant committees will only use the information for evaluation purpose. I will provide references upon request.

Acknowledgment by Submitter: (Reg. Form 6A Rev.3 2024)

Address Line 1

Address Line 2

City

State / Province / Region

Country

Date

Phone / Fax / Viber Number

Email: / Signature: *

WAIVER AGREEMENT & PRIVACY DATA COLLECTION POLICY *

Please click to read and accept in order to proceed.

Please send other useful information to signup@marykyapfoundation or fax to +1 415 901-0305. (Eg. organizational mission and objectives, photos, press-release if available)

The information provided in the above volunteer form is true and accurate. I accept the Terms and Conditions, WAIVER AGREEMENT and PRIVACY DATA COLLECTION POLICY.

I acknowledge that the relevant committees will only use the information for evaluation. I will provide any character reference upon request and after the initial assessment.

Contacts

Clean Water

* indicates a required field.

FORM 6A

Clean Water

The head orphanage/caretaker will initiate the form with the support of the Foundation's Orphanage Ambassador representatives (If Required)

HEAD OFFICE:

PROJECT OFFICE:

PROGRAMS

GET INVOLVED

SEAL OF TRANSPARENCY