APPLICATION FORM A two weeks course on Peace Studies and Conflict Transformation Celebrating Diversity for Peace and Solidarity February 4th to 19th, 2016 Bangkok, Thailand Application Instructions 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. Proficiency in English is required. Academic lectures, discussions and role plays are conducted in English. Application Process Completed application form should be sent to: peacestudies@arf-asia.org with email subject: *Name of applicant* – Application form – 2-week course, February 4th – 19th, 2016 Registration Course Fee: 300 USD The course fee covers local transportation, accommodation and foods. An exposure trip to Chiang Mai is also included. Organizer does NOT provide Airfare and Visa Expenses Venue International Institute of Peace and Development Studies (IIPDS)* Suwintawaong Soi 51, Soi Rom Yen T. Kratumrai, Nong Chok, Bangkok, 10530 * IIPDS is 30 km from Suvarnabhumi and 50 km from Don Mueang airport; located in a peaceful rural setting with a simple and comfortable shared accommodation. Contact Ms. Ha Nguyen 6Mob: +66964 601 699 Tel: +662 988 2101 Fax No.: 66-2-9130197 E-mail: peacestudies@arf-asia.org APPLICATION CLOSE DATE: January 15th, 2016 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 process will take long time TO BE FILLED IN ELECTRONICALLY BY THE APPLICANT 1 Family Name 3 Citizenship 2 Forename(s) 4 Date of Birth (dd/mm/yyyy) Age Personal Details 5 Sex 6 Religion (if any) 7 Mailing Address 7.1 Street Insert your photograph 7.2 Postal Code + City here! 7.3 Country (Compulsory) 8 Telephone 8.1 Mobile 8.2 Fax 9 E-mail (compulsory) 10 Passport Details 10.1 Passport Number 10.2 Country of Birth 10.3 Country of Issuing Passport 10.4 Issue date 10.5 Expiry date 11 Emergency Contact 11.1 Name 11.2 Address 11.3 Contact Numbers 12 Additional information 12.1 Food preference 12.2 Please indicate if there is anything else you would like us to know about you: Higher Education 13 Name and Location of University or Institution Length of Studies (From-to) Degree Obtained Major 13.1 13.2 Page 2 of 4 13.3 Attendance of relevant Training, Seminars, etc. 14 Year Country/ City Institution 14. 1 14. 2 14. 3 Type of Training, Seminar, etc. Professional Experience (starting with most recent – please give details) 15 Date Country Organisation – Title of Main Tasks (from mm/yy to Company Position (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 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 the course and how this training can affect your future activities and in what ways? (Not more than 100 Words) 18 REFERENCES Page 3 of 4 19 Reference 1 (details) Name Organization Relationship Email IPDS/ARF/ AMAN Affiliation Reference 2 (details) Name Organization Relationship Email IIPDS/ARF/ AMAN Affiliation I hereby certify that the information shown above is true and correct Signature of the Applicant: Date: 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 Page 4 of 4