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MATTER Innovation Hub Application

Please complete all questions to the best of your ability. If you have any questions, please contact Jeremy Newhouse at MATTER (jeremy@matter.ngo).

Agency's Full Name:(Required)

Website:(Required)

Date of Program Establishment:(Required)

MM slash DD slash YYYY

NGO Verification

Please check only one of the following

NGO Verification:(Required)

This agency is a 501(C)3 organization that is not a privately funded foundation or municipality (please upload a copy of your 501(C)3 letter below).

This agency does not have a NGO.

Upload NGO Verification 501(c)3 letter(Required)

Max. file size: 100 MB.

US Primary Contact Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position(Required)

Phone(Required)

Email(Required)

In-Country Primary Contact

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position

Phone

Email

In-Country Program Information

Primary Site Name (if different than Organization Name):

Please indicate education provided (please check all that apply):(Required)

Primary School

Secondary School

Job Skills Training

Technical School

Student Body Percentage of Boys(Required)

Student Body Percentage of Girls(Required)

Site Address (or final destination where the MATTER Innovation Hub will be delivered)(Required)

Have you shipped a container to a school before?(Required)

Yes

No

You indicated you shipped a container to a school in the past. Please describe how you cleared customs.(Required)

Primary School Enrollment:(Required)

Secondary School Enrollment:(Required)

Other School Enrollment:(Required)

Total School Enrollment:(Required)

Please describe how MATTER's Innovation Hub will be used to serve the student population.(Required)

Program Funding

Please indicate percentage of funding for your program (complete all that apply):

Client Fees

Grants

Benevolence Fund

Private Donations

Government Funds

Fundraisers

Other

Please list other agencies from whom you receive support (materials & resources, not funding):

Please indicate services offered at the school (Please check all that apply):(Required)

School Laboratory

Computer Lab

School Feeding Program

Other Information

How did you hear about the MATTER Innovation Hub?(Required)

Please provide a narrative outline of your program. Include any relevant information you may wish to share to help us determine whether a partnership with your organization would be a good fit with MATTER:(Required)

Comments

This field is for validation purposes and should be left unchanged.

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