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Organisation Name : *


or International

 Details of the organisation

Organisation website (URL):

Organisation type (please tick one or several):

 Contact person for media interviews

Note: Personal contact information will not appear on the website but may be made available to the media and you may be contacted by email.

Family Name:

First Name:




 A. Title of the project /initiative

Please provide a short title *

 B. Description of the project activities

Please provide a brief description, in 2000 characters or less.

(500 characters remaining)

 C. Characteristics of the project


Country of implementation

Region of implementation

Cross-cutting issues


 D. Timeline

Please indicate when and where this project /initiative has been/ is being/ will be implemented

Place and date of the launch

Is there an embargo on releasing information to the media

if yes, Date/Time

 E. Context

Please provide a brief description of the links between this project and existing activities undertaken to implement the WSIS action lines, or to the outcomes of the Tunis Phase of the Summit, as well as to other contexts (e.g., achieving the goals of the Millennium Declaration).

(500 characters remaining)

 F. For more information

Please provide a website, a document or other source of information:

Website URL (you may enter several URLs separated by a space)

Other information:

(200 characters remaining)

 G. Coverage

Please tick the appropriate boxes to indicate the coverage of the project activities

Please specify coverage

(250 characters remaining)

 H. Activity type

Please tick one or more boxe(s) to indicate the type of activity described above

Other, please specify:

 I. Partnership

If Yes, please indicate the names of all the main partners involved in this activity

(500 characters remaining)

 J. Financial Commitment

Please indicate the approximate level of financial commitment by all partners (including in-kind resources): *

Specify (optional)

(250 characters remaining)



Fields with a red star (*) indicate mandatory answers