Beneficiary registration and support request

Supporting Individuals, Strengthening Families, Transforming Communities

RJWF is committed to supporting vulnerable individuals and families through health, humanitarian assistance, empowerment, and community development programs. Information is kept confidential and used solely for assessment, program planning, service delivery, monitoring, evaluation, safeguarding, and impact reporting.

Secure client-side form

Beneficiary registration form

Please complete this form so RJWF can understand your needs and determine the most appropriate support services available. Contact: remmyjwellnessfoundation@gmail.com

remmyjwellnessfoundation@gmail.com

Full Name *Gender *Date of Birth *Age *Phone Number *WhatsApp NumberEmail AddressResidential Address *Community / Town *Local Government Area (LGA) *State *Marital StatusTotal Household Size *Monthly Income RangeBeneficiary Category *Area of Support Needed *Most Pressing Household Challenge *Health Condition or Support Needs (Optional)Next of Kin / Emergency Contact Full Name *Next of Kin / Emergency Contact Phone Number *Relationship to Applicant *Consent and Data Protection Statement *I confirm that this information is accurate and consent to RJWF collecting and processing it for beneficiary assessment, service delivery, monitoring, evaluation, reporting, safeguarding, and donor compliance purposes.

Important notice

Applications are reviewed fairly

Submission of this form does not automatically guarantee assistance. Applications are reviewed according to eligibility criteria, available resources, program priorities, and funding availability. Eligible applicants will be contacted when support opportunities become available.

Our program areas

Support built around community needs

Elderly Care & Healthy AgeingCommunity Health EducationHumanitarian Assistance and ReliefWomen, Girls and Youth EmpowermentFamily Strengthening and Social SupportCommunity Development and WASH ProjectsMaternal and Child HealthVolunteer and Community Engagement