Community Hosts

Organisation Information

Name of organisation *

What is the official name of your organisation

10 words left

Type of organisation *

What kind of community organisation are you?

community center

community art venue

coworking space

faith-based institution (such as a gurdwara, mosque, church, temple...)

innovation hub

local sports club

public library

school

youth center

other

Where is your organisation based?

Address *

City *

Country *

Share with us at least one website that will help us understand you better. *

for example, your organisation’s website, a social media profile, a video, or pictures of your community

How many people work for your community organisation? *

how many people (paid staff and volunteers) are working full-time in your organization?

1-2 full-time equivalent

3-5 full-time equivalent

6-10 full-time equivalent

> 20 full-time equivalent

Primary Contact

Name

First Name *

Last Name *

Age

This form is not intended to collect the information of individuals under the age of 16.

Role *

State your formal title in the organisation

10 words left

Email Address *

Phone Number

We will be only using your phone number if you wish to be contacted via phone.

Secondary Contact

Secondary point of contact (optional)

Name

First Name

Last Name

Role

State your formal title in the organisation

10 words left

Age

This form is not intended to collect the information of individuals under the age of 16.

Email Address

Phone Number

We will be only using your phone number if you wish to be contacted via phone.

Community

Do you have a physical venue? *

Yes

What is the seating capacity of your venue? *

Please estimate the number of people your venue can host

What is the primary language spoken by your community? *

5 words left

What other languages are spoken by your team?

20 words left

How would you describe the community you bring together and host? *

150 words left

How would you describe the activities and purpose of your community? *

Please briefly introduce to us your community’s activities, and any common values or purpose that you share.

200 words left

On June 24, we selected 100 points on the globe by Sortition.Check the sortition map and learn more from here.

Are you located near any of the 100 points on the GA sortition map? *

Yes

Near which point(s) that are you located? *

List all of the points that you are close to

How close you are from that specific point ? *

Within 200km radius

Further than 200km radius

Please paste the location(s) of your organization from Google Maps

Copy your satellite location from Google Maps

Which of the following is available in your organizations or you can provide

Computer / Laptop

Good internet connection & bandwidth

At least one staff member that is proficient in English

At least one staff member that is familiar with video conferencing applications(i.e Zoom, Microsoft Teams,..etc)

Local language translation ability

Enough human resources to support GA

Any other information you would like to share about your organization and your community?

150 words left

Communication

What secondary channel you would like us to use for communication. *

Email is the primary channel of communication

Phone

Viber

Other

None

Please tell us how do you prefer to be contacted *

25 words left

How did you hear about the Global Assembly *

Select all that are appropriate

Social Media

News Outlet

Other Media Outlet

Another member of your community

Other

Please tell us how you heard about the Global Assembly

25 words left

May we send updates about the Global Assembly to the contacts you provided? *

Yes

Community Hosts Form

Secondary point of contact (optional)