Request Backup Power for Earthquake Relief
Please list electrical power needs for earthquake relief work at temporary shelters or rural villages in Nepal needing support. We will share this information with local solar companies and both national and international relief agencies to solicit help. Filling this form does not guarantee you will get support, however this will share your request with a broader audience who are willing to provide help for Nepal earthquake victims. See all submitted requests at http://nepalquake.ghampower.com/request-map
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Name of Person Making Request *
Please type your full name
Contact Phone
your best contact number (preferably mobile)
Contact Email *
Location Name
What is the name of the site / neighborhood?
Location Address *
Where is the site located? Please provide full address  - put in only street name, city or VDC name, and disrict for address. Putting in "just down the street from the school" doesn't work well when relief workers are trying to find your site from the address you type here.
Google Map Latitude
Right click on map marker, choose "What's Here", and copy latitude coordinates (e.g. Tundikhel should be "27.702799, 85.315517", so type "27.702799" in the field below))
Google Map Longitude
Right click on map marker, choose "What's Here", and copy longitude coordinates (e.g. Tundikhel should be "27.702799, 85.315517", type "85.315517" in the field below)
Location Type *
Is the location a temporary shelter, a remote village, or something else? Please note we only serve relief work
Number of Light Bulbs Needed *
Approximately how many light bulbs are required for basic lighting?
Number of Mobile Phone Chargers Needed *
Approximately how many mobile phones need to be charged at a time at a minimum?
Other Appliances
List other appliances that need to be powered and their power requirement in Watts
Additional Notes
Any other information that will help assess the need better
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This form was created inside of Ghampower.com.