Asian Forum for Human Rights and Development

APPLICATION FORM Regional Training of Trainer on ASEAN Human Rights Mechanisms 2016 (ASEAN HR TOT 2016) Jakarta, 26-30 November 2016

Photo1 1. Personal data

Name First Name: Surname: Date of Birth dd-mm-year Sex ( )M ( )F Nationality Passport No. in Passport Address

Tel Home country code –area code- number Mobile Fax country code –area code- number Email Skype ID Do you have special need(s)? Do you have dietary restriction?

2. Organization data

Organization Position Brief Description of Your Duties

Address

Tel Office country code –area code- number Mobile Fax country code –area code- number Email

1 Please attached an electronic file of your passport size photo in your application’s email

1 3. Experience(s) in conducting human rights training

1) List the 3 most recent trainings that you have conducted, your role in the training team (please specify – e.g. lead trainer, co-facilitator, resource person) as well as target participants.

No. Title of a Training Dates Your Role Target Participants 1

2) Please rate the level of your experience in conducting human rights trainings: 1= absolute beginner; 6= very experienced Please select ( )1 ( )2 ( )3 ( )4 ( )5 ( )6

3) Which of the following area(s) are you most confident in conducting as a human rights trainer: Tick as many as appropriate ( ) Structuring a training session ( ) Developing training methodologies ( ) Facilitating the group discussion ( ) Giving a presentation ( ) Answering questions ( ) Other – please specify:

4. Experience(s) in using/ engaging ASEAN human rights mechanisms and/or other ASEAN institutions

1) Which of the following have you engaged? Tick as many as appropriate ( ) Engaging in the AICHR at the national and/or ASEAN level Please specify the occasion: ( ) Engaging in the ACWC at the national and/or ASEAN level Please specify the occasion: ( ) Engaging in the ACMW at the national and/or ASEAN level Please specify the occasion: ( ) Engaging with other ASEAN institutions, Please specify the institution and occasion:

2) Please briefly elaborate your experience(s) chosen in question 1 in the space below.

5. Experience(s) in involving in CSOs forum/network in ASEAN region

Which of the following CSOs forum/network in ASEAN region have you engaged? Tick as many as appropriate ( ) Engaging in the ASEAN Civil Society Conference/ ASEAN People’s Forum (ACSC/APF) Please specify the occasion: ( ) Engaging in the SAPA regional consultation on ASEAN and Human Rights Please specify the occasion: ( ) other CSOs platform/ network:….. (please fill) Please specify the occasion:

6. Follow-up plan In your own words, please describe the reason how participation in this training will be useful for your work on human rights? (± 250 words)

7. Follow up plan After attending the ASEAN HR TOT 2016, which serves to be Training of Trainers, we expect that the participants will conduct trainings on ASEAN Advocacy in their countries or within their network. Please briefly outline whether or not conducting such trainings is feasible with regards to availability of resources, availability of training materials in local languages, cooperation from your host organization, etc.

8. English Proficiency The training will be conducted in English. All materials for the training will be in English. Providing any copy of certificate of English course, TOEFL, IELTS will be more preferable. If there is no formal certificate can be provided, please underline the “YES” below if you can follow the training in English without any translation support.

Herewith I declare that I do not need any translation support during the training. YES

3 9. Supporting Document(s)

Please list down any supporting documents, which could support your application: 1. Latest CV (curriculum vitae) 2. Endorsement/ supporting letters from FORUM-ASIA members/ SAPA members 3. Supporting letters from your organization 4. Other(s) documents where relevant

Signature: Date:

Completed applications and supporting documents must be sent to FORUM-ASIA by email to [email protected] no later than Monday, 31 October 2016