register

GAP Changemakers receive access to the many programs offered and support from other GAP community members. To become a part of the GAP community, please fill in your details in the registration form below.

  • The form will take around 10 minutes to complete
  • Please note : fields marked in asterisk ( * ) are mandatory
Username: (Please create a username that will be used for identification). *

a) Name of Changemaker: *

a1) First Name: *
a2) Middle Name (optional):
a3) Last Name/Initial: *
b) Mobile Number: *
c) Email Id: *
d) Gender:*
e) Age: *
f) Name of the Organization:*
g) How would you like to be contacted:*

h) Address for communication:*

h1) Address Line1:*
h2) Address Line2:*
h3) Country: *
h4) State *
i) Languages Known:*
Hindi English Others
(Please type below)
Read
Write
Speak
j) How did you hear about GAP:*
k) What is the stage of your work in poverty eradication/ Social impact:*
k1) Started since:

l) Domain/Area of focus: *

l1) Primary Domain:*
l2) Secondary Domain:*
m) Please describe your initiative/project:*
n) Please describe why you are committed to eradicating poverty? *
o) Please describe the Vision Statement of your project? *
p) Describe the impact of this Initiative in your words? *
q) How do you propose to grow/ increase the impact of this project in the coming years? *
r) Photograph:*

" Recommended image size - 170x170px, Supported file types - jpg, png, JPEG "

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