Intake form

Help us serve you better

Name *

Email address *

What is your relationship to the beneficiary?

How did you hear about the educate a child campaign?

Please select at least one option.

Social Media

Friend or Family

Community Event

School Announcement

What type of support are you seeking?

Please select at least one option.

Financial Assistance

Educational Materials

Scholarships

Mentoring Programs

Please specify the age of the child in need of support.

What is the current educational level of the child?

Please provide the name of the school attended by the child.

What challenges is the child currently facing in their education?

Would you like to be contacted for follow-up?

Additional questions or comments

Sorry, we were not able to submit the form. Please review the errors and try again.

EDUCATE A CHILD CAMPAIGN