Wellbeing Contribution

Let's grab some details to get your action on the record.
This form should be super simple and take no more than five minutes.

Remember, you own the data that you record on the East Coast Exchange and any data that will be publicly displayed will have a 'Public' label below the field.
This action was completed by

IndividualOrganisation/Group
Organisation
Public
Contact name*

Public
Email*
Phone number*
Are you completing this form on behalf of someone else?

YesNo
Record your name here

First NameLast Name
Your phone number
Yes, I have their consent to record this information

YesNo - please get their consent before continuing

How would you like your action to show up on the record?
I would like to

Volunteer or donate my time / goods / services. Any Action Points I earn I would like to be donated back to the community effort.Earn Action Points that could be eligible for Programme funding.
How you price your contribution in Action Points is totally up to you!

Remember:
- 1 point = 1 NZD but funding isn't guaranteed.
- You may want to think about how how much it cost you to take this action in terms of time / equipment / supplies or the impact you are creating.
- It will be publically visible. It might be helpful to check out the record to see how others have priced their actions.
How many Action Points would you like to earn / donate?
Public
Optional: Add any notes about how you arrived at this points value

Let's capture some quick info so we can verify this
Your points are only earned or donated if your actions can be verified so please supply high-quality evidence below.
Upload image or evidence of your contribution

Please include photo evidence (where possible) of the volume and type of resources avoided or reused
Cancelof
Name of someone who can verify your contribution
Phone number for this person

I have read and agreed to the Exchange Rules.I understand that this is not an offer of employment. I am volunteering my time and I do not expect to receive a reward in return.I understand there is no guarantee that I will receive any Programme funds at any time or that my donated points will be funded.
View the East Coast Exchange rules here.
Should be Empty:

Let's grab some details to get your action on the record.