Civil Society Organization Form
       
  Organization Name
       
  in Indonesian :
  in English :
  Abbreviation :
       
  Contact Details
       
  Contact Person :
  Position :
  Address :
  City :
Post Code :
  Phone :
- Fax :
  Mobile phone No. :
  Email :
  Website :
       
  Organization Profile
       
  Type of organization : NGO/LSM Research Institute Foundation
      Association Religious organization Labour union
      other, please specify :
       
  Year established :
  number of staff :
  number of volunteers :
  Funding source :
  Annual expenditure on peacebuilding :
 
       
  Activities
       
  Which of the following peacebuilding activities did your organization devote the greatest amount of time to over the past 2 years. (Please assign a number 1-5; with 1 for the most amount of time spent, down to 5 (if appropriate) for the least amount of time)
       
 
promoting human rights reconciliation/negotiation/mediation
civic education trauma counseling
advocacy/lobbying peace journalism/media strategies
democratization conflict area development/rehabilitation
research/conflict analysis gender issues
early warning/fact finding civil society strengthening
dialogue facilitation promoting tolerance and pluralism
promoting good governance/rule of law others, specify :
 
       
  Which of the following peacebuilding activities does your organization plan to focus on in the next two years?
       
 
promoting human rights reconciliation/negotiation/mediation
civic education trauma counseling
advocacy/lobbying peace journalism/media strategies
democratization conflict area development/rehabilitation
research/conflict analysis gender issues
early warning/fact finding civil society strengthening
dialogue facilitation promoting tolerance and pluralism
promoting good governance/rule of law others, specify :
 
       
  Geographic Area
       
  At what level does your organization undertake peacebuilding activities?
  Village Province/City National International
       
  What are the main geographic areas in you undertake peacebuilding activities?
(Select as many as relevant)
 
Bali East Nusa Tenggara Riau
Bangka-Belitung Gorontalo South Kalimantan
Banten Jambi South Sulawesi
Bengkulu Lampung South Sumatera
Central Java Maluku Southeast Sulawesi
Central Kalimantan Nanggroe Aceh Darussalam West Jawa
Central Sulawesi North Maluku West Kalimantan
DKI Jakarta North Sulawesi West Nusa Tenggara
East Java North Sumatera West Sumatera
East Kalimantan Papua Yogyakarta Special Region
       
  Networking
       
  Which Indonesian organizations does your organization work with regularly?
 
   
  To facilitate the distribution of this questionnaire and the completed directory, please provide contact information for these organizations
       
 
Organization Name :
Contact person :
Address :
Email :
 
Organization Name :
Contact person :
Address :
Email :
 
Organization Name :
Contact person :
Address :
Email :
 
Organization Name :
Contact person :
Address :
Email :
       
  Which international organizations does your organization work with regularly?
 
       
  Services
       
  What services and resources are you able to offer other peacebuilding organizations?
       
 
training/capacity building, in :   organization development.  
  workshops   peacebuilding skills.  
  training materials      
       
 
information exchange (publications, internet, etc.)
research
project collaboration
technical assistance/advice
networking
other, specify :
 
       
  Narrative
       
  Please briefly describe your organization and activities
 
       
       
 
       
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