QuestionPro Survey - TOMS Giving: next chapter

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Thank you for your interest in the next chapter of One for One! TOMS is excited to be expanding our model to help save and restore sight to people in need. At this time, we are not seeking additional Sight Giving Partners. Please feel free to enter your organizational information below, and we will be sure to keep it handy for future reference.
All the best, TOMS

Your organization's name

Organization's mailing address (including country)

Website

Contact person

Email Address

Phone number (including country code)

Are you a registered NGO or non-profit organization?

Yes

For which countries would you seek support?

Which of the following does your organization provide? Please include how many of each you have provided in the past 12 months, as well as the percentage that were provided free of charge to patients.

	Yes/no	# in past 12 months	% free
Cataract and other sight-saving surgeries

Refraction and prescription glasses

Medical treatment / eye care

Reading glasses

If your organization provides additional eye care services not listed above, please list them here:

Do you conduct any capacity building activities with local programs?

Yes (please describe in box below)

Thank you!