Figure A.1: Elements of empathy
| NAME | ID | PLACE OF RETURN (region, city or village) |
|---|
1. SUMMARY OF RETURNEE’S PLAN
2. TYPE OF REINTEGRATION ASSISTANCE TO BE PROVIDED
IMMEDIATE ASSISTANCE
☐ CASH ASSISTANCE
☐ BASIC NEEDS (FOOD, CLOTHES, AND SO ON)
☐ ACCOMMODATION
☐ MEDICAL
☐ OTHER
LONGER TERM ASSISTANCE
☐ CASH FOR WORK
Does it need a referral?
ECONOMIC
☐ INCOME-GENERATING ACTIVITY (CREATION OR STRENGTHENING)
☐ INDIVIDUAL MICROBUSINESS
☐ COLLECTIVE PROJECT
☐ COMMUNITY PROJECT
☐ OTHER
Does it need a referral?
If yes, please specify
☐ JOB PLACEMENT
Does it need a referral?
☐ VOCATIONAL TRAINING
Does it need a referral?
SOCIAL
☐ HOUSING SUPPORT
Does it need a referral?
☐ MEDICAL SUPPORT
☐ RETURNEE
☐ FAMILY
Please specify
Does it need a referral?
☐ EDUCATIONAL SUPPORT
Does it need a referral?
☐ SKILLS DEVELOPMENT
Does it need a referral?
☐ LEGAL SERVICES
Does it need a referral?
☐ SOCIAL PROTECTION SCHEMES
Does it need a referral?
☐ CHILD CARE
Does it need a referral?
☐ SPECIAL SECURITY MEASURES
Does it need a referral?
PSYCHOSOCIAL
☐ INDIVIDUAL AND FAMILY LEVEL ACTIVITIES
Does it need a referral?
☐ COMMUNITY LEVEL ACTIVITIES
Does it need a referral?
☐ OTHER (PLEASE DETAIL):
Does it need a referral?
3. INDICATIVE LIST OF THE GOODS, EQUIPMENT AND SERVICES TO BE PURCHASED WITH THE REINTEGRATION GRANT AND CORRESPONDING ESTIMATED VALUE
| GOODS, EQUIPMENT, SERVICES | ESTIMATED COST |
|---|---|
| TOTAL |
4. LIST OF REFERRALS TO BE MADE
| AGENCY | ASSISTANCE TO BE PROVIDED |
|---|---|
5. EXPECTED IMPROVEMENT OF THE RETURNEE’S PSYCHOLOGICAL, SOCIAL AND ECONOMIC WELL-BEING AFTER THE ASSISTANCE IS PROVIDED
BASELINE REINTEGRATION SCORE
6. IN THE EVENT THAT THE PROJECT IS ENVISAGED AT COMMUNITY LEVEL (SUCH AS A GROUP OF RETURNEES AND LOCAL COMMUNITY MEMBERS), INDICATE THE NAME OF EACH RETURNEE AND COMMUNITY MEMBER INVOLVED AND, IF ALREADY DEFINED, THEIR RESPECTIVE ROLES IN THE PROJECT
| NAME | ROLE |
|---|---|
DONE ON [DATE] IN [LOCATION]:
APPROVED BY [RETURNEE’S NAME AND SIGNATURE:
APPROVED BY STAFF OR REFERRAL PARTNER’S NAME AND SIGNATURE: