Name of the Orphan and Vulnerable Children Care Center:
Location(Village,Ward,Division,and District):
Address/PO Box:
Director or Contact Person:
Title:
Telephone 1:
Telephone 2:
Fax:
E-Mail Address:
Website:
Type of OVC Center:
Part Time (Day Care)
Full Time (Home)
Full and Part Time (Home)
Other
What is the main focus of your center:
Formal education
Informal education
Only Lodging
Only Help
Food, Clothing, Medicine and Lodging
Other
Number of children at your OVC Center:
Boys:
Girls:
Total:
Total capacity of your center:
How many of the children are tested for HIV/AIDS:
How many of the children are in school:
What is the number workers/staff available at the Center?
Men:
Women:
Total:
Can we refer more abandoned children/orphans to your center?
Yes, we'd love to help more kids
No, we are at maximum capacity
How many Orphans and vulnerable children do you help every year:
When did your center begin to operate? :
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1992
1993
1994
1995
1996
1997
1998
1999
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
8:00 AM
8:30 AM
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
8:00 PM
8:30 PM
9:00 PM
Have you registered with Social Welfare:
Yes
No
If yes, what is your registration number:
If no, why and what other organizations are you registed with:
Do you offer any type of training skills at your center:
Yes
No
If yes, what do you teach:
What additional services do you offer to the Orphans and Vulnerable Children:
Which geographical areas within Tanzania does your organization work:
Do orphans need to pay in anyway to benefit from your services: Yes
No
If yes, how:
List the current basic needs of your center:
Need 1:
Need 2:
Need 3:
Need 4:
Need 5:
What areas could you use our help to build your capacity:
Help 1:
Help 2:
Help 3:
Help 4:
Help 5:
Would like a volunteer to help at your Center: Yes,we'd love some help with the kids
No,we have to many people already
If yes, how many:
Can they sleep at the center:
What do you want the Volunteers to do for you:
Job 1:
Job 2:
Job 3:
Job 4:
Job 5:
What will you provide for the volunteer:
Benefit 1:
Benefit 2:
Benefit 3:
Benefit 4:
Benefit 5:
What other organizations and/or Centers do you work with and know that you provide services to the Orphans and vulnerable children?
What is the current annual budget of your Center:
USD:
What are your five major sources of funding for your Center:
Funding 1:
Funding 2:
Funding 3:
Funding 4:
Funding 5: