ICAE Academy of Lifelong Learning Advocacy - IALLA
APPLICATION FORM
A) Personal Details
| 1) Full name (please underline surname) |
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| 2) Date of Birth ______ _______ _______ Month Date Year |
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| 3) Sex Male Female |
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| 4) Nationality |
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| 5) Mailing/Postal address |
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| 6) Telephone number / fax number |
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| 7) E-mail |
B) Language skills
| English Listening [ ] excellent [ ] good [ ] poor Speaking [ ] excellent [ ] good [ ] poor Writing / reading [ ] excellent [ ] good [ ] poor |
| Mother tongue: _____________________ |
| Other languages: ___________________________ |
C) Educational Background
| Institution |
City / country |
Years attended |
Degree obtained |
Subject |
D) Work Experience
Describe present and previous jobs, stating dates, employer / organization, type of employer / organization and post description.
| Name of employer |
Type of employer |
Position held |
Post description |
Dates |
E) National (and/or regional) activist involvement during the last five years
State the organizations / groups you have worked with, the issues / campaigns you have worked on and describe the results (in not more than one page).
F) Local, regional, or global advocacy experience
Give details of any advocacy experience you have had at local, regional and global level, stating when, where, the issues addressed, and describe the results (in not more than one page).
G) Personal statement
Explain the reason why you consider you should be selected and the contributions you think you could make after the event, that is to say, how you plan to use the knowledge and skills acquired through IALLA (in not more than one page).
H) Course expectations
Say what you would like to get out of this course, and what you think you can contribute/bring to it (in not more than one page).
I) Funding for Attendance
(Please place an X in the appropriate space)
____ I can personally afford the costs of the course.
____ I have already applied for a scholarship.
(Please specify in which organization)
_______________________________________
____ I have been granted a scholarship
(Pleases specify by which organization)
_______________________________________
____ I cannot afford the costs of the course.
J) Applicant’s declaration
I hereby certify that the statements made by me in this form are true and correct to the best of my knowledge, and in case I am accepted I agree:
i) not to bring any member of my family.
ii) to follow the course of study and abide by the rules of institution or establishments with which I undertake to study or train.
iii) to submit any progress report or evaluation questionnaire which may be prescribed.
iv) to hold a health insurance or contract one before travelling, in order to cover any possible expenses due to unforeseen health incidentals (at my expense)
v) to return to my home country at the end of my course of study or training.
Signed…………………………………………….……….………… Date ………………………………….
Application form and curriculum vitae (not more than 4 pages) should be submitted as follows:
- One electronic copy to secretariat@icae.org.uy
- One copy to the following address:
ICAE - Acevedo Díaz 1600 apto. 1002, Montevideo 11200, Uruguay
Letters of recommendation from two referees should be sent directly from the referees to the Selection Committee, to the same address or by Fax: (598-2) 401 00 06
The deadline for the receipt of application form, curriculum vitae and referee letters of recommendation, is fixed on June 15.