Distribution Report

This form belongs to Multifaith Alliance to document distribution activities carried out by partner organizations in the field. All submitted information is confidential and used exclusively for evaluation and reporting purposes.

Full Name

Include first and last name

Organization Name

Position / Title

Phone Number

Enter your full phone number with country code (e.g. +1 212 555-0100)

Email Address

A submission confirmation will be sent to this email address.

Approximate Number of Direct Beneficiaries

Approx. % of Children Under 18

Enter 0 if none

Approx. % of Women (18+)

Approx. % of Elderly People (65+)

As a percentage of all adult men and women (18+).

Approx. % of People with Disabilities

As a percentage of all beneficiaries.

Beneficiaries' Conditions Before Assistance

1 = Very Poor 5 = Good

Most Affected Areas Before Assistance

Food Access

Health Conditions

Financial Burden

Sense of Safety

Other

Please specify (Other area)

Please upload at least one photo or video, or provide an external link below.

Upload Photos & Videos

Accepted formats: JPG, PNG, WebP, MP4, MOV. Max 5 MB per file · Max 100 MB total · Up to 20 files.

You can provide an external link instead of uploading files, or use both. At least one of the two is required.

Large Files — External Link (Optional)

Optionally provide a link to files hosted on Google Drive or another cloud service. You can use this instead of (or in addition to) uploading files above.

I confirm the accuracy of all information provided and authorize Multifaith Alliance to use and share this data for evaluation, reporting, and coordination purposes.

Distribution Report

Basic Information

Distribution Information

Beneficiaries Information

Impact Measurement

Documentation