2015 Capacity Building Seminar on Organisational Development
- Needs Assessment and Application Form -

Question Title

* 1. Personal Details

Full Name:

Pronoun (how you prefer people to refer to you):

Date of Birth:

Age:

Country of Residence:

Phone (inc country code):

Email:

Question Title

* 2. Organisational Details

Organisation Name:

Location:

Year Established:

Website:

Your Position in Organisation:

Please indicate the areas in which your organisation works and add any comments you think necessary. You can fill in for more than one box. If the box does not apply to your organisation, please leave it blank.

Question Title

* 3. Organisational Needs Assessment

	All the time	Sometimes	Occasionally	Never/not yet	Unsure
Your organisation works at the Structural level: working with outside entities to increase the inclusion of the LGBTQI people (lobby, advocacy, policy, litigation)	Your organisation works at the Structural level: working with outside entities to increase the inclusion of the LGBTQI people (lobby, advocacy, policy, litigation) All the time	Your organisation works at the Structural level: working with outside entities to increase the inclusion of the LGBTQI people (lobby, advocacy, policy, litigation) Sometimes	Your organisation works at the Structural level: working with outside entities to increase the inclusion of the LGBTQI people (lobby, advocacy, policy, litigation) Occasionally	Your organisation works at the Structural level: working with outside entities to increase the inclusion of the LGBTQI people (lobby, advocacy, policy, litigation) Never/not yet	Your organisation works at the Structural level: working with outside entities to increase the inclusion of the LGBTQI people (lobby, advocacy, policy, litigation) Unsure
Your organisation works at the Structural level: working with the general public to raise awareness (media campaigns, cultural events), working to educate public/private service providers (such as police, health workers, education workers, etc)	Your organisation works at the Structural level: working with the general public to raise awareness (media campaigns, cultural events), working to educate public/private service providers (such as police, health workers, education workers, etc) All the time	Your organisation works at the Structural level: working with the general public to raise awareness (media campaigns, cultural events), working to educate public/private service providers (such as police, health workers, education workers, etc) Sometimes	Your organisation works at the Structural level: working with the general public to raise awareness (media campaigns, cultural events), working to educate public/private service providers (such as police, health workers, education workers, etc) Occasionally	Your organisation works at the Structural level: working with the general public to raise awareness (media campaigns, cultural events), working to educate public/private service providers (such as police, health workers, education workers, etc) Never/not yet	Your organisation works at the Structural level: working with the general public to raise awareness (media campaigns, cultural events), working to educate public/private service providers (such as police, health workers, education workers, etc) Unsure
Your organization works at the Community level: working with the LGBTQI community to increase awareness, strength and voice of people, organising community events, groups, education or cultural activities.	Your organization works at the Community level: working with the LGBTQI community to increase awareness, strength and voice of people, organising community events, groups, education or cultural activities. All the time	Your organization works at the Community level: working with the LGBTQI community to increase awareness, strength and voice of people, organising community events, groups, education or cultural activities. Sometimes	Your organization works at the Community level: working with the LGBTQI community to increase awareness, strength and voice of people, organising community events, groups, education or cultural activities. Occasionally	Your organization works at the Community level: working with the LGBTQI community to increase awareness, strength and voice of people, organising community events, groups, education or cultural activities. Never/not yet	Your organization works at the Community level: working with the LGBTQI community to increase awareness, strength and voice of people, organising community events, groups, education or cultural activities. Unsure
Your organization works at the Individual level: providing services to individuals (outreach, counselling, legal representation, health services, etc)	Your organization works at the Individual level: providing services to individuals (outreach, counselling, legal representation, health services, etc) All the time	Your organization works at the Individual level: providing services to individuals (outreach, counselling, legal representation, health services, etc) Sometimes	Your organization works at the Individual level: providing services to individuals (outreach, counselling, legal representation, health services, etc) Occasionally	Your organization works at the Individual level: providing services to individuals (outreach, counselling, legal representation, health services, etc) Never/not yet	Your organization works at the Individual level: providing services to individuals (outreach, counselling, legal representation, health services, etc) Unsure

Please tell us more about your answers above

Please rate your organization from 1 to 5 (1 is the weakest and 5 is the strongest) in the following areas. Please make any comments that can give us a better picture of your needs.