IPT APPLICATION FORM

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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: [email protected] 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: [email protected]
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
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