The. April 22 2026

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The. April 22 2026

Registering a request for humanitarian assistance

We are always keen to support families and individuals in dire need, so we ask you to fill out this form accurately and honestly, as applications will be reviewed based on specific criteria to ensure that support reaches those who truly deserve it.

All information you provide will remain strictly confidential and will only be used to assess the situation and provide appropriate assistance.

⚠️ Important Note: Filling out the form does not automatically guarantee assistance. We will only contact accepted cases and may conduct a field visit to verify the information.

Applications with incomplete information or blank fields will be ignored without review.

• Full name (your name, father's name, and surname)

• Mother's full name:

• Date of birth (day-month-year):

• Gender:

male

feminine

• marital status:

Single

Married

Widower

divorced

• Your email address:

• Mobile number:

• Address (City - Neighborhood - Street):

Have you previously registered with us for a humanitarian assistance request?

Yes

no

• Number of family members:

• The complete family structure:

Children under (5 years old)

Children (5-17 years old)

Youth

Seniors (60+)

• Number of children in the school:

Are there any children who have dropped out of school?

Yes

There is no

• Job status and work:

unemployed

Temporarily working

It works continuously.

Unable to work

• Is there a primary source of income?

Yes

There is no

• Source of income:

Daily work

Permanent job

Freelance work

Foreign transfers

Aid

Additional sources of income:

• Value of monthly income:

Less than $50

From $50 to $100

From $100 to $200

More than $200

Are there any debts?

Yes

There is no

Approximate debt value (optional):

• Do you receive assistance from other sources?

Yes, permanently

Yes, intermittently

I received it once

no

• Type of accommodation:

king

rent

shared accommodation

Shelter center

Otherwise

If something else is specified, where?

• Housing status:

Good

average

bad

• Is electricity available in the residence?

Yes

no

• Is water available in the accommodation?

Yes

no

Yes, it is not suitable for drinking.

• Is heating available in the accommodation?

Yes

no

• Heating source:

wood

Fuel (mazut)

electricity

nothing

• Rental value (optional):

• Is the family having difficulty securing food?

Yes, always

sometimes

no

Are there any chronic diseases?

Yes

no

If yes, specify the chronic diseases?

drunken

pressure

Heart disease

respiratory diseases

Other chronic diseases:

• Is there a person with a disability?

Yes

no

• Type of disability:

physical

mentality

visual

auditory

• Are there any conditions that require ongoing treatment?

Yes

no

• Special cases:

widow

divorced

Aynam

Supporter of a (missing/detained) person

displaced

pregnant woman

breastfeeding

A child suffering from malnutrition

• Specify what the family owns (car/motorcycle/farmland):

car

motorcycle

agricultural land

nothing

• Type of assistance required:

Financial assistance

Food baskets

medical aid

Educational support

heating

clothes

House restoration (not currently available)

Other assistance:

• How much help is needed:

Very urgent

Medium

It's possible to wait

• Documents you possess and can show us:

Personal identity

Proof of residence

Medical reports

• Briefly explain your general situation:

• I acknowledge and affirm the accuracy of the information provided, and by clicking the (Submit My Data) button, I agree to:

My data is used for assistance purposes only.

My data may be used for assistance purposes and for any other secure activities that do not cause me any harm or exploitation.

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