APPLICATION FORM
WEST AFRICAN YOUTH - PARLIAMENTARY LEADERSHIP FORUM ON NEPAD
“Ensuring the participation of young people and Members of Parliament in innovative and creative thinking geared toward engendering democracy, good governance and human rights in West Africa”
(Please type or write LEGIBLY in CAPITAL LETTERS)
Candidates should send their application forms and position papers by email to:
West African Youth /Parliamentary Forum
Telephone: + 228 902 10 38
Fax: + 228 227 93 66
Email: Nepad Youth Forum
nepadyouth@cooperationtogo.net
nepadyouth@yahoo.fr
Coordinators:
1- Richelieu Marcel Allison
Regional Director, West African Youth Network
Freetown, Sierra Leone
Email: wayn_regional@yahoo.com
2- André Kangni AFANOU :
Focal point of WAYN-Togo
Président of Novation Internationale
Email: aafanou@yahoo.fr
Website: http://www.cooperationtogo.net/nepadyouth
Lomé TOGO
Applicants are encouraged to send their applications by e-mail to facilitate communication and to speed up the process of selection.
We must receive the applications no later than 1st march 2005.
Approximately 40 candidates and 10 members of parliament will be invited to participate in this conference from among the applications received by the deadline. Those candidates accepted to participate will be informed by 15th march and will subsequently receive information by post, including a full programme and other relevant details.
PART I
Personal Information
Surname:
First Name:
Nationality:
Age :
Sex :
Address :
Telephone :
Daytime:
Other:
Fax: e-mail:
Organisation / Faculty / Network:
Address:
Telephone:
Fax:
Is your organisation / faculty part of an international network? If yes, please specify:
Working Languages: (please mention ALL languages you can work in):
English: (Very good, Good, Fair)
French: (Very good, Good, Fair)
Have you any special needs or requirements (e.g. dietary, disability, etc.)
Request for financial support for travel costs
Do you wish to receive financial support to cover your travel costs?
Yes No
If YES, please enclose a letter explaining and justifying your need for financial support, stating the amount of your request in United States Dollars and Euros. In addition, please enclose proof (quote from a travel agency) of the cost of the ticket you wish to purchase, and state the percentage of your entire travel costs this amount represents. Participants are strongly encouraged to seek alternative sources of funding to cover their travel costs.
Participation fee
Will you be in a position to pay the participation fee of 10 Euros?
Yes No
If NO, please enclose a letter explaining and justifying your need for the participation fee to be waived. Applicants are strongly encouraged to request that the sending organisation or an alternative funding source cover this participation fee.
Date of Birth:
Passport Number:
Issued at (place):
On (date):
Date of expiry:
Date:
Signature:
PART II
1. What is your experience and/or knowledge concerning the theme of this conference?
2. What is the special interest of your organisation in the theme of this conference? How can you personally/ possibly your organisation benefit from participating in this conference?
3. What is your personal motivation for applying to participate in this conference? How can you personally contribute to the event? Why do you think it should be you not someone else to be selected for participation?
4. What do you expect to gain from participating in this conference? What concretely do you think you can do with the experience/ knowledge/ contacts gained at the conference? Are you planning on taking up any specific activity/ project?
5. List all the conferences and seminars you attended in the past
6. Any other comments?
Please return this application form and don’t forget to attach a approx. 100 word Essay about your “Vision on NEPAD” to the following address, fax number or e-mail address at the latest by 15th march 2005. (Applications without the Essay will not be considered for selection)
Please note that sending in the application form is not a confirmation of acceptance to participate in the conference. Applicants accepted to participate will be informed by 15th March 2005 by the conference organisers.