Ipt Application Form

APPLICATION FORM Training Workshop on Youth for Peace Empowering Youths, Empowering Humanity

19th-23th December 2017 Bangkok, Thailand COURSE 2017 Application Instructions

 Representatives from socially engaged youth organizations, peace and development workers from NGOs, faith based organizations, peace and human rights activists, youth leaders, researchers, journalists, young scholars and development professionals who are active in peace studies or peacebuilding programs are encouraged to apply for this program.

 Please do not apply if you do not have strong English skills. Proficiency in English is required. If you are accepted you will be required to participate in academic lectures, discussions and role plays in English.

 Registration Fee: USD 150 Send the following documents to [email protected] (Please clearly specify the name of the course you are applying for, in the Email Subject Line) . Completed application form . Curriculum Vitae (with photo passport size) . Registration fee to be paid upon arrival at IIPDS

 Venue Suwintawaong Soi 51 T. Kratumrai, Nong Chok, Bangkok, 10530

(The Training Center in Nong chok is 35 kms from central Bangkok in a rural residential setting with simple and comfortable shared accommodation with peaceful environment)

APPLICATION CLOSE DATE: November 25th, 2017 Incomplete applications will not be accepted

Applicants from those countries where there is no Royal Thai Consulate are recommended to apply early for the course as the visa processing will take longer time

TO BE FILLED IN ELECTRONICALLY BY THE APPLICANT 1 Family Name 3 Citizenship

of 4 2 Forename(s) 4 Date of Birth (dd/mm/yyyy) Age 5 Do you identify as an Indigenous person? Yes No. If yes, please specify

Personal Details 6 Sex 7 Religion (if any) 8 Mailing Address 8.1 Street Insert your photograph 8.2 Postal Code + City here! 8.3 Country (Compulsory) 9 Telephone 9.1 Mobile 9.2 Fax 10 E-mail (compulsory) 11 Passport Details 11.1 Passport Number 11.2 Country of Birth 11.3 Country of Issuing Passport 11.4 Issue date 11.5 Expiry date 12 Emergency Contact 12.1 Name 12.2 Address 12.3 Contact Numbers Higher Education 13 Name and Location of University or Length of Degree Obtained Major Institution Studies (From-to) 13.1 13.2 13.3

Attendance of relevant Training, Seminars, etc. 14 Year Country/ City Institution Type of Training, Seminar, etc. 14.1 14.2 14.3

Professional Experience (starting with most recent – please give details) 15 Date Country Institution/ Position Main Tasks (from mm/yy to Organization (Short Description) mm/yy) 15.1 15.2 15.3 Language skills (please start with your native language) 16 Scale 1 – 3 (1 = Basic; 2 = Good; 3 = Excellent) Language Understood Spoken Written Read

of 4 16.1 16.2 16.3

What motivates you to apply for this training course? (Not more than 100 Words) 17

What is your expectation from this course? (Not more than 100 Words) 18

How this training can affect to you future activities and in what ways? (Not more than 100 Words) 19

 I hereby certify that the information shown above is true and correct

Signature of the Applicant: Date:

of 4 Declaration of the Applicant: By submitting this “Application Form” I confirm that all the information given in this form is correct and complete. I also confirm that I agree to the following conditions of participation:  I am motivated, willing and available to engage in civilian peace-keeping and peacebuilding activities  I will not arrive late or depart early  I understand that the training institute reserves the right to exclude the participant from the course in case information given in the form proves to be incorrect (i.e. insufficient language skills) or because of misconduct at the training site