1- Contact details

First name

Last name

Organisation name

Job title

Email

Organisation website

2- Quick overview of the organisation

What does your organisation do?

How do you currently store or manage your data?

Multi choice

Client or service user records (e.g. personal details, contact info, case notes)

Service delivery data (e.g. types of support provided, sessions delivered, service use over time)

Attendance or participation

Referral data (e.g. how clients found you, who referred them)

Donor or fundraising data

Programme or project outcomes (e.g. change in wellbeing, progression, skills gained)

Impact data (e.g. broader organisational or community-level impact)

Financial or operational data (e.g. budgets, grants, resource use)

Other

Multi choice

What would you hope to gain from this pilot? (e.g. clearer reporting, better decision-making, confidence with data, etc.)

Will your organisation be able to share existing data with us as part of the pilot? (Required to participate)

Note: Shared data can be informal—e.g. spreadsheets, PDFs, reports, or other formats. We don’t require a polished database.

Note on Data Confidentiality

We take data privacy seriously. Any data you share will:

You are welcome to remove or anonymise personal data before sharing. If needed, we can also advise on safe sharing practices.

Who will be the main contact person for this pilot?

(If different from the person completing this form)

Please indicate Name Job Title / Role / Email Address

I understand that this is a short-term pilot and that MSI will provide feedback and recommendations, with no obligation to continue beyond the pilot.

Agree

Disagree

I consent to Mosaic Social Impact processing my data for the purposes f the pilot