27th Annual Regional Human Rights & Peoples Diplomacy Training Program

October (TBC) 2017.

Timor-Leste

Application Closing Date: June 30, 2017.

Application Form

Candidates should emaila completed application form* to . Please include 2 letters of recommendation from referees. Letters should be a maximum of one (1) page in length. Incomplete application will not be considered.

Applications will be acknowledged on receipt. Applicants will be notified of the outcome of selection soon after the closing date.

*Please do not include any information that you think might affect your security

PART 1. APPLICANT’S INFORMATION

First Name(s)as it appears on your passport: / Family Name(s) as it appears on your passport:
Preferred name or nickname: / Country:
Male/Female / Year of Birth:
Preferred email: ** / Alternative Email:**
Telephone (including country & area code): / Mobile phone (including country & area code):
Home Address:
Do you identify as an Indigenous person/member of an ethnic minority? Y/N
If Yes, please specify:
Name of organization/cause you work for:
Your position in the organization:
Phone Number at work (including country code):
Organization’s postal address:
Organization’s email: / Organization’s website:
PART 2: YOUR WORK AND EXPERIENCE
  1. Present Occupation:(Please provide your title and a brief description of your duties)

  1. Write two (2) activities undertaken by your organization in relation to community advocacy/ Indigenous peoples/ human rights in your country and your direct involvement in those activities.Describe your role or responsibilities.

  1. Please tell us how this training program will assist you and your organizationin workingfor Indigenous peoples/human rights? How will you apply what you hope to learn in this program to your organization?

PART 3: EDUCATION
What level of education have you completed? Please mark ‘X’ in the appropriate square:
Primary / Secondary / Tertiary
Please list all your Degrees or Courses successfully completed, the year obtained, and name of school or institution: (Please list)
Other training, including previous human rights training: (Please state name of training, year taken and name of institution)
PART 4:REFEREES
Please include 2 letters of recommendation with your application. Letters should be a maximum of one page in length.Name 2 referees with email and telephone.
(Please nominate 2 people who know your NGO and/or your human rights work. It is preferred if at least one referee occupies a senior/supervisory position in your organisation.)
Name of Referee (1):
Title / Position of Referee:
Phone Number: / Email Address:
Name of Referee (2):
Title/ Position of Referee:
Phone Number: / Email Address:
PART 5: SPONSORSHIP
How will you fund your travel expenses and the course fee of US $4000 (which covers food, accommodation, materials and training fee)?
I / my organisation will be able to pay a course fee of US $4000 as well as travel expenses.
I request a financial subsidy for a course fee of US $4000 only and I / my organisation will cover my travel costs.
I request a full financial subsidy including a course fee of US $4000 as well as my travel costs.
Do you or your organization work in partnership with other NGOs or government organisations? Please list names of these organizations.

How did you hear about this training? ______

Date completed: ______