APPLICATION FORM
Tostan’s Human-Rights Approach to Community-led Development: A Hands-On Workshop
March 13 – 22, 2018
Please send your completed application form and CV to . The application deadline is 12 January 2018. Selection of candidates will be confirmed by 26 January 2018.
Personal Information
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First Name:
Last Name:
Nationality:
Date of birth
Sex:
Email:
Telephone (with international code):
Postal Address:
City/Country:
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Please provide a short biography (max. 100 words):
Employment Information
Name of current employer (if applicable):
Will you be representing this organization at the training? YES NO
Type of organization (i.e. NGO, government):
Job title/Position:
Provide a brief summary and structure of your organization (include vision and mission):
Name three of the most important tasks you undertake in your position:
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Professional Affiliations
(Secondary employment or other organizations that you volunteer or consult for)
Name and type of organization:
Will you be representing this organization at the training? YES NO
Job title/Position:
Provide a brief summary and structure of your organization (include vision and mission):
Name three of the most important tasks you undertake in your position:
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Expectations
Indicate how you expect this training to enhance your personal/professional/volunteer goals:
Indicate what specific concepts, methodologies, tools or other ideas you would like to learn about during this training:
The TTC team expects our participants to actively contribute to the training. What qualities will you bring to enhance the training experience for everyone?
Familiarity with Tostan
Are you already familiar with Tostan? (If yes, please specify):
How did you learn about this training?
(Please select applicable answer)
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Email from Tostan staff
Tostan website
Social Media
Other (please specify):
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Scholarship Application
(NB: Only African nationals are eligible to apply for a scholarship. Scholarships do not include flight or other travel costs to arrive in and leave from Dakar, or per diems).
Do you intend to apply for a scholarship? YES NO
In case you were not awarded a scholarship, would you still attend the training? YES NO
How are your values aligned with Tostan’s vision and mission? (250 words max).
How do you plan on using the knowledge learned at the training to benefit your work and your community? (250 words max).
Payment Information
Are you responsible for the financial costs of this training including travel, per diem and the training price? YES NO
If no, please provide the contact information of the individual or organization that will cover travel and training costs:
Name of organization (if applicable)/ contact person:
Contact telephone number:
Contact email:
Postal address:
FOR YOUR INFORMATION
Payment is due by Friday February 16th 2018. An invoice will be emailed to you upon confirmation of selection. Online payments will be accepted via direct deposit.
Cancellation notifications received in writing by the payment deadline will be eligible for a full credit to a future workshop. Registrants who cancel after the payment deadline will receive a credit of the fee paid less a $100 cancellation penalty.Registrants not present for the workshop without prior notification will forfeit the full registration fee.
Substitutions are accepted up to and including the date of the workshop. Please provide a written request tomailto: indicating the name of the original registrant and the name/contact information for the substitute attendee. Sharing of registrations is not permitted.
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