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PWD Registration
PWD Registration for Individuals
PWD Registration for Care Givers
PWD Registration for Organizations
PWD Login
Contact Us
PWD Registration for Care Givers
Region of Registration
Eastern Region
District of Registration
Suhum Municipal Assembly
Year of Registration
First Name of Care Giver
Last Name / Surname of Care Giver
Middle Name of Care Giver
Username of Care Giver
Password of Care Giver
Confirm Password
Sex of Care Giver
Male
Female
Age of Care Giver
Birthday of Care Giver
Mobile Number of Care Giver
Ghana Card of Care Giver
Voters Card Number of Care Giver
Occupation of Care Giver
Community of Care Giver
Abenabo No.1
Abenabo No.2
Aboabo
Abrodiamu
Abrodiamu
Adarkwa
Adentam
Adidiso
Adogogye
Afransidedewa
Ahenbromu
Ajate
Akorabo
Akote
Ali
Amanshia
Amede
Amoakrom
Ampedwa
Anomankwanta
Apete
Aponapona
Asiedu
Asikafo Amantem
Ateebu
Autie Mary
Ayebromu
Ayekotse
Ayisaa
Ayisikrom
Bana
Betiase
Bosompa
Brabiom
Brong Densuso
Cocoano
Dabge
Dademantse
Dawa
Dedewa No.1
Densuso
Doctor Mable
Fieso
Fitanyano
Gariba Zongo
Gboayetse
Gorjiase
Jato
Kofi Anim
Kofiboafo
Kofigya
Kofikini
Kokobibiem
Kokotiesua
Koponya
Koransang Bana
Koransang Kese
Koransang Ketewa
Kradaso
Krobom
Kromameng
Kudovo
Kudovo
Kukua
Kwabena-Kumi
Kwahyia
Kwampo
Kwanatey
Lenya
Mamedonya
Mamehyieso
Mangoa
Mempaaba
Metemano
My Name
Nankese
Nartey Osei
New Life
Nkantinkwan
Nsuta-Wawase
Ntabea
Ntabea
Ntunkum
Numess
Obeng-Down
Obomofodensua
Obretema
Obuodakaa
Obuotunpan
Odokote
Ojobi
Okanta
Okonam
Okorase
Omenako
Otwe
Pobi
Praprabebida
Sakunya
Samatare
Samatare
Sanse
Santramo
Santramor
Sawa
Sra
Suhum 44
Sumie
Supresu
Tei Mensah
Tenya
Teteh Nkwanta
Tetekasom
Tome
Triao
Trotor
Vokorno
Volta House
Webeku
Whyese
Yaw Badu
Yaw Badu Junction
Yaw Boadi
Zorh
House Number of Care Giver
Digital Address of Care Giver
Relationship of Care Giver to Care Recipient
Father
Mother
Brother
Sister
Uncle
Auntie
Friend
Son
Daughter
Husband
Wife
other
Please type your relationship with the care recipient
Hours of Care Giving
Number of Years of Care Giving
Name of Person Receiving Care
Sex of Care Receiver
Male
Female
Age of Care Receiver
Birthday of Care Receiver
Phone Number of Care Receiver
House Number of Care Receiver
Type of Disability of Care Receiver
Persons with physical disabilities
Deaf persons
Person who are non-verbal
Persons with communication disabilities including speech and language disabilities
Persons who are hard of hearing
Persons with visual disabilities
Persons with multiple disabilities such as deafblind
Persons with psychological disabilities
Persons with cerebral palsy
Persons with bipolar conditions
Persons with attention deficit disorders
Persons with schizophrenia
Persons with developmental and neurological disabilities
Persons with autism
Persons with Down Syndrome
Persons with Turner Syndrome
Persons with spinal injury
Persons with autoimmune conditions
Persons with osteogenesis imperfecta
Persons with albinism
Persons with intellectual disabilities
Persons with epilepsy
Persons with leprosy
Little persons
Persons with hunchback
Burns survivors
Other disabilities ( click here to type disability if not found in the above list)
Other Disability
Care Giver Profile Picture
Click Here to Upload Picture of Yourself
Care Giver Profile Picture
Click Here to Upload Picture of Yourself
Upload a Picture of the Care Receiver
Click here to Upload a Picture of the Care Receiver
Upload a Picture of the Care Receiver
Click here to Upload a Picture of the Care Receiver
Past Fund Beneficiary
Yes
No
Past Fund Beneficiary Date
What Support did you receive in the past?
Income Generation
Education
Health
Past Fund Beneficiary Type Specifics
Do you wish to apply for support from the District Assembly Common Fund ( DACF) for the care receiver?
Yes
No
Purpose of Applying for the Fund ( Care Givers)
Basic Needs
Utility Bills
House Rent
Others ( click here to type)
Other Purpose for applying for the fund (Care Givers)
What is the total amount of money required for the the purpose you applied for the fund ?
Please attach supporting documents ( school fees bills, medical bills, etc. )
Click here to upload your supporting documents
Please attach supporting documents ( school fees bills, medical bills, etc. )
Click here to upload your supporting documents
Signature ( I certify that all answers are true to the best of my knowledge )
Only fill in if you are not human
