Stakeholder Details
- Name: ______________________________________
- Organization/Affiliation: ________________________
- Position/Role: _________________________________
- Community/Area Represented: ___________________
- Date of Input: _________________________________
2. Stakeholder Type
(Please check one)
- Community Member
- Local NGO or CBO
- Traditional Leader
- Local Government Official
- Faith-Based Organization
- Youth Representative
- Other (please specify): ____________________________
3. Perceived Most Urgent Issues
Please list the top 3 issues affecting your community in order of priority:
Briefly explain why you believe these are the most urgent issues:
4. Impact on the Community
- Which groups are most affected by these issues?
(e.g., women, youth, people with disabilities, unemployed, etc.) - What are the consequences if these issues are not addressed?
5. Community Strengths and Resources
- What existing resources or community strengths can be leveraged to address these challenges?
6. Suggested Solutions or Interventions
- What actions would you recommend to solve or reduce these problems?
- Who should be involved in implementing these solutions?
7. Willingness to Participate
- Would you or your organization be willing to contribute to a local initiative addressing these issues?
- Yes
- No
- Maybe
If yes, in what capacity?
8. Additional Comments
Please provide any further comments or suggestions related to community needs or engagement:
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