31Oct2024

Making a Difference ●Building Dreams ● Creating Impact ● Saving Lives

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Contacts

HEAD OFFICE:                          548 Market Street,
San Francisco, CA 94104         USA

PROJECT OFFICE:                  Pearl Condo, Bldg A, 15 Fl., Kabar Aye Pagoda Rd.,      Yangon, Myanmar

hello@marykyapfoundation.org

US: +1 415 991 2030                 US: +1 415 799 8282                    MM: +95 9 977 66 7777

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US TAX ID: EIN 47-2687230   Registered No. CT0271616  

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Clean Water

Home Clean Water
* indicates a required field.
This questionnaire is for orphanages joining the #H20Hope2025 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 04A

Clean Water

Pure Water, Healthy Lives

Step 1 of 2

1) ORPHANAGE INFORMATION:

3) ORPHANAGE LEADERSHIP (Primary people in charge)

4) CLASSIFICATION OF ORPHANS/NON ORPHANS:

5) ENGLISH LANGUAGE SKILLS AMONG LEADERS:

6) OTHER ASSESSMENTS:

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

1. WATER SUPPLY AND USAGE:

2. IRRIGATION NEEDS:

3. CHALLENGES AND CONCERNS:

Mark all the possible specific water quality issues at the orphanage for drinking and irrigation use. (Check all that apply)

4. ENVIRONMENTAL CONSIDERATIONS:

5. INFRASTRUCTURE AND AVAILABLE RESOURCES:

6. COMMUNITY ENGAGEMENT:

7. PROJECT COMMITMENT AND LONG-TERM SUSTAINABILITY:

8. ADDITIONAL COMMENTS:

9. OTHERS:

Click or drag a file to this area 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 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 is completed.

Please kindly send back the completed form as well as attach other useful information to (hello@marykyapfoundation.org or fax at +1415-463-8478)
(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.