Form

WHRD Window Application Form – Safety Net (Flexible Funding)

Current Location (*if different from origin)

First name*

Last name*

Number of Dependents 0-17 Years at risk/supported through this application*

*A dependent is a child under the age of 18 or family member residing with you and who you are responsible for their care and well-being. If no dependents, enter 0

Number of Dependents 18+ at risk/supported through this application*

*A dependent is a child under the age of 18 or family member residing with you and who you are responsible for their care and well-being. If no dependents, enter 0

Secure email address*

*A secure email address is an address you are OK to be contacted through to further discuss your application. If you feel that contact with WPHF may put you at risk we suggest that at minimum you use a secure computer, safe internet connection and open a separate, new email account and provide this address in the application instead.

Phone number/WhatsApp/Signal*

please provide a secure way to contact you, including country code. You can include a second number or an alternative contact and number in case we have trouble reaching you. Please enter numbers only. Do not include spaces or dashes.

If referred by a UN agency or other organisation, please name the organisations.

Are you applying for yourself or on behalf of a WHRD?*

For myself

On behalf of a WHRD

If the application is completed on behalf of a WHRD, please provide your contact information.

Secure telephone number

Affiliated Organization (if applicable):

Are you part of an organization/network?
If so, please provide the name and website (if available).

1. Please briefly describe your experience as a woman human rights defender. How have you been peacefully leading human rights activities in your community/country?*

Please include names of any organizations or individuals you have been collaborating with (World Limit: 200-400)

2. What targeted threats have you faced or fear to face because of your human rights/peace activities? Also describe if and how these threats have affected your dependents.*

Word Limit: 200-400

3. When specifically did these threats happen? Please include the history/patterns and timelines of threats faced. *

4. How do these targeted threats affect your ability to continue your work? *

Word Limit: 200-400

5. What do you urgently need to protect yourself and/or your dependents and to sustain your human rights and peace activities? *

Word Limit: 200-400

6. Please note if not all needs can be covered, which ones are a priority to improve your security situation.*

Word Limit: 100-200

7. How much funding you are requesting in USD.
*Please note the maximum amount that can be requested is $10,000 USD. Specify the main line items (needs)

Item/Need 1*

Budget 1*

Item/Need 2

Budget 2

Item/Need 3

Budget 3

Item/Need 4

Budget 4

Item/Need 5

Budget 5

8. Estimated duration this funding will contribute to your safety (months).*

Please note the maximum duration of the support is 6 months.

9. For us to be able to assess your application, please provide the name and contact information of at least one reference from a national or international organization who knows your work and available to answer questions. This reference should NOT be a family member.
*References are provided on a volunteer basis and should not be paid

Reference 1 (mandatory)*

Reference Telephone/Mobile*

*include country code

Reference 2 (Optional)

Provide full name, affiliated organization, email address, telephone/mobile

10. Please let us know if you have submitted a similar application to another organization, and/or received support (financial/non-financial) from one before, as this will help us with coordination.*

If you have received support in the past this will not automatically affect your eligibility.

Yes

If yes, please name the organization, when was the support, and what support was requested/funded.

(Optional) Feel free to share or attach additional information (weblinks, documents, etc.)

I agree that my application can be transferred to an INGO partner of the WPHF Window for WHRDs*