GAP Changemakers receive access to the many programs offered and support from other GAP community members. To become a part of the GAP community, please fill in your details in the registration form below.

  • The form will take around 10 minutes to complete
  • Please note : fields marked in asterisk ( * ) are mandatory
Username: (Please create a username that will be used for identification).*

1) Name of Changemaker:

1a) First Name:*
1b) Middle Name (optional):
1c) Last Name/Initial:*
2a) Mobile Number:*
3) Email Id:*
d) Gender:*
e) Age: *
f) Name of the Organization:
g) How would you like to be contacted:*

h) Address for communication:*

h1) Address Line1:*
h2) Address Line2:*
h3) Country:
h4) State (Optional)
i) Languages Known:*
Hindi English Others
(Please type below)
Read
Write
Speak
j) How did you hear about GAP:*
k) What is the stage of your work in poverty eradication/ Social impact:*
k1) Started since:

l) Domain/Area of focus: *

l1) Primary Domain:*
l2) Secondary Domain:*
m) Please describe your initiative/project:*
n) Please describe why you are committed to eradicating poverty?
o) Please describe the Vision Statement of your project?
p) Describe the impact of this Initiative in your words?
q) How do you propose to grow/ increase the impact of this project in the coming years?
r) Photograph:

" Recommended image size - 170x170px, Supported file types - jpg, png, JPEG "

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