This resource is an intake form that CHAK uses with its clients who are people living with HIV.
Or, access this resource as a guest by sharing your email below.
Last updated January 30, 2013.
Welcome to the grassrootsjusticenetwork.org website (the “Site”), operated by Namati, Inc., a Delaware corporation (“Namati”, “we”, “us” or “our”). Your use of the Site or use of any of the services offered on or via the Site (collectively, the “Services”) is subject to these terms of use (the “Terms”). We may modify the Terms at any time without notice to you by posting revised versions of the Terms on our Site. Your use of the Site and any Services constitutes your binding acceptance of the Terms and Namati’s Privacy Policy, including any modifications that we make. If you do not agree to the Terms, do not use this website.
You must register in order to upload Tools to the Tools Database, obtain full access to Tools, participate in discussion forums and fully utilize any networking functions on the Site. To register, you must be 18 years or older, have the requisite power and authority to enter into the Terms, truthfully and accurately provide all required information, including a legitimate email address, and obtain a unique username and password.
You are responsible for maintaining the confidentiality of your account and password, and you agree to accept responsibility for all activities that occur under your account or password. Furthermore, you are strongly advised to maintain and to protect your privacy by choosing carefully what personally identifiable information you provide on the Site.
Your use of the Site is at your own risk, including the risk that you might be exposed to Content that you find offensive or that is inaccurate, objectionable or otherwise inappropriate. Your use of the Site constitutes your acknowledgment that you bear all risks associated with using such Content.
Our Site includes a combination of content that we, our users and other third parties create (collectively, the “Content”). All of the Content available through the Site including, but not limited to, written content, photographs, graphics, images, illustrations, marks, logos, sound or video clips, and animations, is trademarked or copyright protected. Content posted to the Tools Database at grassrootsjusticenetwork.org/tools (such content, the “Tools”) is intended to be used as part of a platform provided for practitioners to share experiences and resources, including, but not limited to, research, training materials, monitoring and evaluation tools, case management systems and advocacy strategies. You may use a Tool to assist in performing issue advocacy consistent with the mission of Namati as published at https://grassrootsjusticenetwork.org/about/our-mission (the “Mission”), provided that your use of a Tool must in no way violate any law of the jurisdiction in which such Tool is used. Except as permitted herein, you may not use, store, display, modify, reproduce, publish, transmit, participate in the transfer or sale of, create derivative works of, distribute, publicly perform, publicly display or in any way exploit any of the materials or content on the Site in whole or in part.
You are solely responsible for all materials, whether publicly posted or privately transmitted, that you upload, post, email, transmit or otherwise make available on the Site (“Your Content”). You represent that you own or have the necessary permissions to use and authorize the use of Your Content as described herein. You may not imply that Your Content is in any way sponsored or endorsed by Namati. You assume all risks associated with posting and sharing Your Content, including anyone’s reliance on its quality, accuracy or reliability. Prohibited content includes, but is not limited to, and you represent that you will not post Content that is:
We may from time to time, examine the Content on the Site or at the point of upload. We have the right, but not the obligation, to remove or decline to post any Content that may, in our sole discretion, violate these Terms or that is otherwise objectionable to us. We are not responsible for the loss, deletion, failure to store, misdelivery or untimely delivery of any Content submitted to or transmitted through the Site. We have no obligation to retain or provide you with copies of Your Content, nor do we guarantee any confidentiality with respect to Your Content. You may not post, or attempt to post, Content that interferes with our normal operations or with the use and enjoyment of another user. You may access the Site and the Content only through the interfaces provided by us. You agree to use the Site and the Services only for their intended lawful purpose and in accordance with applicable laws.
You certify that either (i) you own all intellectual property rights in Your Content, or (ii) in posting or transmitting Your Content, you are acting with the permission of the owners of such Content to both (a) post such Content and to (b) grant any further licenses to such Content or permissions to use such Content as described herein. When you post or transmit Your Content on or through the Site you grant Namati a perpetual, worldwide, irrevocable, royalty-free, nonexclusive and sublicensable license (the “License”) to use, reproduce, create derivative works of, distribute, publicly perform, publicly display, transfer, transmit, distribute and publish Your Content and subsequent versions of Your Content for the purposes of (i) displaying Your Content on the Site, (ii) distributing Your Content, either electronically or via other media, to users seeking to download or otherwise acquire it, (iii) storing Your Content in a remote database accessible by end users, and/or (iv) providing Services through and outside of the Site, including, but not limited to, implementing interventions expanding legal empowerment, offering technical assistance to development organizations, governments and civil society actors and hosting workshops for members. The License shall apply to the distribution and the storage of Your Content in any form, medium or technology now known or later developed.
When you post or transmit Your Content on or through the Site you also irrevocably grant the users of the Site the right to access and use Your Content in connection with the use of the Site.
If we request registration information from you, you will provide us with true, accurate, current and complete information. If you are registering on behalf of an organization, you represent that you have the necessary permissions and/or authority from that organization to (i) register the organization as a member of the Site and (ii) act on behalf of and in the name of that organization in any interactions with the Site, including, but not limited to, posting of Content to the Tools Database and discussion forums. You will promptly update your registration or that of your organization to keep it accurate, current and complete. If we issue you a password, you may not reveal it to anyone else and you may not use another person’s password. You agree to immediately notify us of any unauthorized use of your passwords or accounts or any other breach of security. We will not be responsible for any loss or damage that may result if you fail to comply with these requirements. The technology and the software underlying the Site and the Services is the property of Namati and our contractors. You agree not to copy, modify, rent, lease, loan, sell, assign, distribute or reverse engineer any of the technology or software underlying the Site or the Services. You agree not to modify the software underlying the Site in any manner or in any form or to use modified versions of such software, including, without limitation, for the purpose of obtaining unauthorized access to the Site.
Without limiting the foregoing, you agree that you will not use our Site to take any of the following actions:
If you choose a username that, in our sole discretion, is obscene, indecent or abusive, we reserve the right, without prior notice to you, to automatically change your username, delete your posts from the Site, deny you access to the Site or employ any combination of these options. Unauthorized access to the Site is a breach of these Terms and a violation of the law. You agree not to use any automated means, including, without limitation, agents, robots, scripts or spiders, to access, monitor or copy any part of the Site, except those automated means that we have approved in advance and in writing. Use of the Site is subject to existing laws and legal process. Nothing contained in these Terms shall limit our right to comply with governmental, court and law-enforcement requests or requirements relating to your use of the Site.
We have the right, but not the obligation, to take any of the following actions, in our sole discretion, at any time and for any reason without giving you any prior notice:
You agree that we will not be liable to you or any third party for taking any of these actions. You understand and agree that our Services may include communications such as service announcements and administrative messages from us and that these communications are considered part of the Services. We may also contact you via email to notify you about special events available to Site registrants. By becoming a Site registrant you consent to the receipt of these communications. You will be able to opt out of receiving these messages.
The Site is intended to provide general information about Namati, its mission of legal empowerment and programs and research which we support and to provide practitioners with an online network for the sharing of resources and experiences, including research, training materials, monitoring and evaluation tools, case management systems and advocacy strategies. The Site is not engaged in the provision of professional advice or information. Content posted on the Site should be considered as opinion only and should not be taken as a substitute for, without limitation, legal or other professional advice from a qualified service provider. We make no representations or warranties concerning any action taken by any person in reliance on the information provided through the Site. We will not be liable for any damages that may result, including but not limited to direct, indirect, consequential, special or other damages or economic loss, illness, injury or death.
The Site provides access and contains links to third-party Internet sites and services. Inclusion of these links and services on the Site does not constitute our endorsement of the materials on those third-party sites and does not signify any association with the owners or operators of those third-party sites and services. Your use of such third-party sites and services is subject to the terms and conditions set by the third-party site or service in question. We have no control over these third parties, and we are not responsible for their activities. You may receive email communications from third parties if you utilize a third-party service provided through the site. We do not sell, resell or license any of the products or the services related to any third-party sites, and we disclaim any responsibility for or liability related to them. Your correspondence or related activities with third parties, including payment transactions and goods-delivery transactions, remain solely between you and that third party. You agree that we will not be responsible for or liable for any loss or damage of any sort incurred as the result of any of your transactions with third parties. Any questions, complaints, or claims related to any third-party product or service should be directed to the appropriate vendor.
You represent that you have read, have understood and accept our Privacy Policy (the “Privacy Policy”). Note that we may disclose information about you to third parties if you have requested or authorized the disclosure or if we have a good faith belief that such disclosure is reasonably necessary to (i) take action regarding suspected illegal activities, (ii) enforce or apply our Terms and Privacy Policy, (iii) comply with legal process or other government inquiry, such as a search warrant, subpoena, statute, judicial proceeding or other legal process served on us or (iv) protect our rights, reputation and property, or that of our users, affiliates or the public. Please click here to see our full Privacy Policy.
The Site and Services are offered from the United States. We make no representations or warranties that the Site or Services are appropriate or available for use in countries outside of the United States. Visitors who choose to access the Site and Services from outside of the United States do so at their own initiative and are responsible for compliance with any and all local laws and regulations that may apply to such access. If you use the Site outside of the United States, you consent to having your personal data transferred to and processed in the United States. Access to the Site and the services is prohibited where such access or use violates applicable laws or regulations.
We disclaim any and all responsibility and liability for (i) the deletion, the failure to store, the misdelivery or the untimely delivery of any information or material; (ii) any harm resulting from downloading or accessing any information or material on the Internet using search results from our Site; and (iii) any service outages that are caused by our maintenance on the servers or the technology that underlies the Site, failures of our Service providers (including telecommunications, hosting and power providers), computer viruses, natural disasters or other destruction or damage of our facilities, acts of nature, war, civil disturbance or any other cause beyond our reasonable control. WE DO NOT WARRANT THAT THE SITE WILL BE UNINTERRUPTED OR ERROR FREE. IN ADDITION, WE DO NOT MAKE ANY REPRESENTATION OR WARRANTY AS TO THE CONTENT ON THE SITE. THE SITE AND THE CONTENT ARE DISTRIBUTED ON AN “AS IS, AS AVAILABLE” BASIS. ANY MATERIAL THAT YOU DOWNLOAD OR OTHERWISE OBTAIN THROUGH THE SITE IS DONE AT YOUR OWN DISCRETION AND RISK, AND YOU WILL BE SOLELY RESPONSIBLE FOR ANY POTENTIAL DAMAGES TO YOUR COMPUTER SYSTEM OR LOSS OF DATA THAT RESULTS FROM YOUR DOWNLOAD OF ANY SUCH MATERIAL. WE MAKE NO WARRANTIES THAT (i) THE SITE WILL MEET YOUR REQUIREMENTS, (ii) THE SITE WILL BE UNINTERRUPTED, TIMELY, SECURE OR ERROR FREE, (iii) THE RESULTS THAT MAY BE OBTAINED FROM THE USE OF THE SITE WILL BE ACCURATE OR RELIABLE, (iv) THE QUALITY OF ANY PRODUCTS, SERVICES, INFORMATION OR OTHER MATERIAL THAT YOU OBTAIN THROUGH THE SITE WILL MEET YOUR EXPECTATIONS, OR (v) ANY ERRORS WILL BE CORRECTED. WE MAKE NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE OR NON-INFRINGEMENT WITH RESPECT TO THE SITE, ANY CONTENT OR ANY OF OUR SERVICES, TOOLS, PRODUCTS OR PROPERTIES. YOU EXPRESSLY AGREE THAT YOU WILL ASSUME THE ENTIRE RISK AS TO THE QUALITY AND THE PERFORMANCE OF THE SITE AND THE ACCURACY OR COMPLETENESS OF ITS CONTENT. IN ADDITION, WE DO NOT GUARANTEE THE ACCURACY, INTEGRITY OR QUALITY OF THE CONTENT ON THE SITE, AND YOU MAY NOT RELY ON ANY OF THIS CONTENT. WITHOUT LIMITATION, WE ARE NOT RESPONSIBLE FOR POSTINGS BY USERS IN ANY INTERACTIVE SECTIONS OF THE SITE, INCLUDING, BUT NOT LIMITED TO, THE TOOLS DATABASE. WE SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OF OR INABILITY TO USE THE SITE, EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. SOME STATES DO NOT ALLOW EXCLUSION OF IMPLIED WARRANTIES OR LIMITATION OF LIABILITY FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES, SO THE ABOVE LIMITATIONS OR EXCLUSIONS MAY NOT APPLY TO YOU. IN SUCH STATES, OUR LIABILITY SHALL BE LIMITED TO THE FULLEST EXTENT PERMITTED BY LAW.
By utilizing the Site, you agree to indemnify, defend and hold Namati and all of its officers, directors, employees, representatives, Advisory Council members, Network Guidance Committee members, agents, information providers and licensors (collectively, the “Namati Parties”) harmless from and against any and all liability, losses, costs and expenses (including attorneys’ fees) incurred by any Namati Party in connection with any claim, including, but not limited to, claims for defamation, violation of rights of publicity and/or privacy, copyright infringement or trademark infringement arising out of:
You also agree to take sole responsibility for any royalties, fees or other monies owed to any person by reason of any Content you post or transmit through the Site or the Services we provide. We reserve the right, at our own expense, to assume the exclusive defense and control of any matter for which you are required to indemnify us, and you agree to cooperate with our defense of these claims.
By visiting or using the Site, you agree that the laws of the State of New York, without regard to principles of conflicts of law, will govern our Privacy Policy and these Terms and any dispute of any sort that might arise between you and Namati. You agree that any action at law or in equity that arises out of or relates to any use of the Site will be filed only in the state or federal courts located in New York County, and you hereby consent and submit to the personal jurisdiction of such courts for the purposes of litigating any such action.
Materials may be made available through the Site by third parties who are not under our control. Namati respects the copyright interests of others and, as such, requires our users to comply with all Terms regarding copyrights. It is our policy to terminate user accounts for failure to comply with our copyright policy. If you believe that any Content shown on or transmitted through the Site violates these Terms or your copyright please report the violation. In the case of a copyright violation please provide a written notice with a physical or electronic signature and the following information:
All notices should be sent to our designated agent as follows:
It is often difficult to determine if your intellectual property rights have been violated. We may request additional information before we remove allegedly infringing material.
We may be required by state or federal law to notify you of certain events. You hereby acknowledge and consent that such notices will be effective upon our posting them on the Site, our delivering them to you through email or your otherwise becoming aware of such notices through other means. If you do not provide us with accurate information, we cannot be held liable if we fail to notify you. Our failure to exercise or enforce any right or provision of these Terms shall not constitute a waiver of such right or provision. You agree that regardless of any statute or law to the contrary, any claim or cause of action arising out of or related to use of the Site or these Terms must be filed within one (1) month after such claim or cause of action arose or it will be forever barred. These Terms, including the Privacy Policy, constitute the entire agreement between you and Namati and govern your use of the Site, superseding any prior agreements that you may have with us. If any part of these Terms is determined to be invalid or unenforceable pursuant to applicable law, then the invalid or unenforceable provision will be deemed superseded by a valid, enforceable provision that most closely matches the intent of the original provision and the remainder of the Terms shall continue in full force and effect.
Last updated: May 25, 2018
Welcome to the grassrootsjusticenetwork.org website (the “Site”) and the Grassroots Justice Network forum (the “Forum”), operated by Namati, Inc., a Delaware corporation (“Namati”, “we”, “us” or “our”). We share your concern about the protection of your personal information online. This privacy policy (“Policy”) describes how we maintain the privacy of the personal information we collect online in connection with the Site and Forum.
This Policy describes our privacy practices and sets out your obligations and ours with respect to your use of the Site and the Forum. This Policy applies only to the Site and the Forum and does not necessarily apply to our offline collection of information.
By using the Site and/or Forum, you agree to abide by the terms of this Policy and the terms of use (the “Terms”) and you consent to our using any information that you provide to us or that we collect, in accordance with the terms of use and the terms and conditions of this policy. If you do not agree to this policy and the terms, do not use the site.
Namati may collect and retain two types of information about Site and Forum visitors: (i) personal information that individual visitors voluntarily provide when interacting on the Site or Forum or on certain other occasions (such as via forms or in emails); and (ii) tracking data, which is data that is automatically collected from every Site and Forum visitor as they use and browse the site.
We may, from time to time, store and archive the information you submit to or through the Site and Forum. The information that we gather may include your name, title, and address, telephone number, email address, credit card number or other elements of personal information. In addition, if you contact us, we may keep a record of your correspondence, including any information contained therein.
You may decline to provide any personal information, but please realize that you thereby may be unable to register or to participate in activities or services offered on the Site and/or Forum.
In addition to the information you submit to or through the Site and Forum, we also may collect and store data from and about you gathered in the course of your use of the Site and Forum. We call this “tracking data.”
Such tracking data may include, but is not limited to, information regarding the number and frequency of visits to the Site and Forum, the websites that you access before and after you visit the Site and Forum, the software and operating system used to access the Site and Forum, and your IP address and Internet service provider.
The information that you provide to us and that we may collect in the future is used for our legitimate interests and the purpose for which you provided it only, subject to the terms of this Policy and the Terms of Use.
Our use of your Information involves various forms of communication with you, including:
We will not disclose any personal information to third parties, except:
Information provided to third parties is limited to the information needed to perform their functions. We seek to limit third-party use of information; however, we are not responsible for such third-party use of information.
We retain the right to transfer or assign all information pursuant to a merger, purchase or other transaction relating to Namati or our assets.
The current list of third-party service providers we use include:
Akismet
Reduces spam posts on the Forum.
Privacy notice: https://automattic.com/privacy/
Amazon Web Services
Stores backups for the Site and the Forum.
Privacy notice: https://aws.amazon.com/privacy/
Digital Ocean
Hosts and stores backups for the Forum.
Privacy notice: https://www.digitalocean.com/legal/privacy/
Google Analytics
Compiles visitor statistics on the Site and Forum. You can opt out of Google Analytics using a browser extension.
Privacy notice: https://www.google.com/analytics/terms/
GoToWebinar
Online service for organizing and hosting webinars.
Privacy notice: https://www.logmeininc.com/legal/privacy
MailChimp
Provides mailing list and mail server services for sending newsletters, Forum notifications, and weekly email summaries.
Privacy notice: https://mailchimp.com/legal/privacy/
Salesforce
Online service providing contact management system.
Privacy notice: https://www.salesforce.com/company/privacy/
WP Engine
Provides cloud servers for hosting the Site.
Privacy notice: https://wpengine.com/legal/privacy/
Zapier
Online service to automate adding member data to Salesforce.
Privacy notice: https://zapier.com/privacy/
Personal information you submit via your member account, other than information provided or content posted by you to public areas of the Site as described below, is deleted from Namati’s records following the deletion of your account. However, such information may continue to be retained by third-party service providers to which it has been disclosed for one of the reasons listed above.
Your Information is stored on Digital Ocean servers in New York, USA.
We take reasonable precautions to protect your information from loss, misuse or alteration. You should recognize, however, that there is no such thing as “perfect security” on the Internet, and we cannot guarantee the security of your information. In addition, because Internet communications are unsecure, it is also possible that the information you supply to us or your access of any information via the Site will be intercepted during transmission. We are not liable for any breach of our systems or interception of our transmission, and we hereby fully disclaim, to the fullest extent possible under law, any liability associated with any claim relating to a breach of security, data or information.
You should be aware that any information provided or content posted by you to public areas of the Site, including but not limited to interactions on the Site and information posted to the Member Directory (via your profile), the Tools Database and the Forum, may be read, collected or used by other visitors of the Site, who may not need to log in as a member to view the information. Namati is not responsible for the third-party use of any information provided in such manner. By participating in the use of the Site’s interactive features, you consent to Namati’s use or disclosure of any content that you submit. For more information on posting content, please see our Terms.
The Forum uses data about your posts and other activity to make automated decisions about whether your posts are spam.
The Forum may also use data about your posts and activity to award you badges and calculate a trust level for your account. Your trust level may affect how you can participate in the Forum, such as whether you can upload images, as well as give you access to moderation and management powers in the Forum. Your trust level, therefore, reflects Forum administrators’ confidence in you, and their willingness to delegate community management functions, like moderation.
From time to time, we may email users of the Site or the Forum information regarding important developments affecting Namati and/or the Global Grassroots Justice Network. We may also email users on occasion regarding the Site or the Forum. Such emails may be sent to users of the Site or Forum even if they have not requested to receive any communication from us.
You may choose to unsubscribe from future emails by using the unsubscribe link included in all mass email correspondence from Namati and the Grassroots Justice Network.
If a user elects to use our referral service to inform a friend about the Site and Forum, we request the name and email address of the friend. Namati will automatically send the friend a one-time email inviting the friend to visit the Site. Namati stores this information for the sole purpose of sending this one-time email, and, while a third-party mail service provider may retain the information in its database, no additional emails will be sent by Namati without further action by the friend.
The Site and the Forum may contain links to websites owned and operated by other parties. We are not responsible for and have no control over the privacy policies of those sites. We encourage you to review the privacy policies and terms of use of those sites prior to providing them with any information.
Namati uses cookies. Cookies are small pieces of information that a website transfers to your computer’s hard drive for record-keeping purposes and may have unique identifiers and transmit information about you and how you use the Site. Such information may include your search preferences, your browser type and the date and time of use. If you choose, you can disable some (but not all) Cookies in your device or browser settings, but doing so may affect your ability to use the Site.
Namati does permit several non-advertising third parties to set third-party cookies in order to enhance Site functionality. These third parties may include, but are not limited to: Addthis, Facebook, Google, and Vimeo. For more information on the cookies that these third parties set, users are encouraged to consult the privacy policies and terms of use of these third parties.
Because Namati is concerned about the privacy protection of children who access the Internet, we comply with the Children’s Online Privacy Protection Act (COPPA). Accordingly, the Site and Forum are not intended for use by anyone under the age of 13, and we do not knowingly collect information from anyone under 13 years of age without the consent of a parent or guardian.
We reserve the right to disclose any information to comply with any law, regulation, decree, judgment, order, subpoena or any other governmental order (“Order”) without any obligation to contest or verify the accuracy of such Order.
This Policy will be governed by and construed in accordance with the laws of the State of New York, without regard to any principles of conflicts of law. You agree that any action at law or in equity that arises out of or relates to any use of the Site will be filed only in the state or federal courts located in New York County, and you hereby consent and submit to the personal jurisdiction of such courts for the purposes of litigating any such action.
The section titles in this Policy are for convenience only and have no legal or contractual effect.
The Site, the Forum, and any third party services they use, may be subject to additional terms and conditions regarding privacy and use of information. Your use of the Site and the Forum is subject to those terms and conditions, which are incorporated into this Policy by reference. In the event of an inconsistency between this Policy and any additional posted conditions, the provisions of the additional conditions shall control.
We may need to change the Policy from time to time in order to address new issues and to reflect changes on the Site or in the law. We reserve the right to revise or make any changes to the Policy, and your continued use of the Site subsequent to any changes to this Policy will mean that you agree to and accept such changes. You can tell if the Policy has been updated by checking the last revised date posted on the top of this page.
You can access, remove, update or correct your information in your Site profile and your Forum profile.
You can also access, remove, update or correct your information, and raise any questions or concerns regarding the Site or the Policy, by emailing privacy@namati.org, or mailing:
Namati Data Protection Officer
1616 P Street NW, Suite 101
Washington, DC 20036, USA
If you live in a country which has adopted the General Data Protection Regulation (EU; 2016/679), you have a right to lodge a complaint with your relevant supervisory authority about this policy and its application.
The Policy was updated in May 2018 to comply with the General Data Protection Regulations.