Application Form: Isis-WICCE's 2001 Exchange Programme's Institute
Please print out and complete the application form.
Return the completed form as soon as possible, and not later than July 15th 2001.


PART A: To Be Filled by the Sending Group

    1. Name of the Sending Group:

    2. Name of the person in charge:

    3. Address of the group (mailing and street address):




      Telephone number:
      Fax number:
      E-mail:
      If you do not have any of the above numbers, please give a number where you can receive messages by telephone or fax:



    1. Describe briefly the activities of the group:




    2. How many full-time paid employees are in your group?

    3. How long has the group been operating together?




    1. Why do you feel that the programme will be useful to the group?




    2. Do you have concrete plans to use the experience to further your own work? What are they?







    1. Name of the nominee:

    2. How long has she been with the group?

    3. Her present title:

    4. Briefly describe her activities in the group:




    5. Why is she the most suitable nominee?







  5. Financial Information:
    1. The sending group is responsible for:
      • All expenses of your nominee within her country related to obtaining passports, visas, vaccinations, transportation and communication within the country of origin.
      • All extra personal expenses of your nominee incurred during the programme (personal photocopying, telephone calls, toiletries, tourist trips etc) will be borne by the participant herself, or her sending group.


    2. Isis-WICCE will provide each participant with:
      • A round trip economy class air ticket and transport from the airport to the venue of the institute.
      • Accommodation, food and programme-related transport during the entire period of the programme.
      • Start-off funds for the plan of action drawn up by the participant during the orientation period.


    3. If you know of any extra sources of funding that would be able to support your nominee, please give details:



    4. Would you be willing to submit a joint proposal for the above source with Isis-WICCE to support your nominee?



      Please indicate that you have read, understood and accepted the above financial information:


      Signed: ........................................


      Name:..........................................


      Position:.......................................





PART B: To be Filled by the Nominee

  1. BIO-DATA
    1. Name:

    2. Address (mailing and street address):




      Telephone number:

      Fax number:

      E-mail:


    3. Nationality:

    4. Date of Birth: (Optional but must be an adult)

    5. Passport Number:
      Valid until:

    6. Have you suffered from any of the following diseases?

      Hypertension:
      When

      Heart Disease:
      When

      Diabetes:
      When

      Tuberculosis:
      When

      Malaria:
      When

      Jaundice:
      When


      Please attach a medical certificate from a licensed medical practitioner as proof of your fitness to participate in the programme.

      NB: Pregnancy related expenses, dental care and chronic diseases, eye diseases, and AIDS related illnesses are NOT covered by the insurance provided by Isis-WICCE. These are the responsibility of the participant herself.



  2. EDUCATION AND OTHER BACKGROUND
    1. Please indicate your educational qualifications:
      Period Training Qualification







    2. Please indicate your employment experience:
      Period Position Organisation/Group







    3. Please indicate your language proficiency:
      Language Reading Writing Speaking
      English
      French
      Others: Please specify



    4. Please indicate any other experience you may have-particularly in the women's movement:




    5. Please indicate any international conferences or workshops you have participated in, in the last three years:




    6. Why do you personally want to participate in the Isis-WICCE Exchange Programme Institute?




    7. What are the most important aspects (of you and your work) that you feel you will be able to bring to the programme?




    8. Why do you work around issues of violence against women?




    9. Will the skills you gain benefit other groups in your community/country? YES/ NO Why?




    10. Are you willing to adapt to other people's culture and food?




Please return this form along with:
  1. Letters of reference from two women's groups or women activists (not working in your group, but who have known you for at least two years).
  2. A curriculum vitae.
  3. Medical certificate.
  4. A recent photograph.
  5. Annual Report, and any other information describing your group and its work.





AGREEMENT OF PARTICIPATION:

(to be signed the Sending Organisation and the Nominee)


We, the undersigned, declare that the above information provided by us is true. We have read and understood the Terms and Conditions for participation in the Isis-WICCE Exchange Programme's Annual Institute for 2000/ 2001, and agree to them. Should our selected nominee leave the programme prematurely without the written consent of the Exchange Programme Coordinator and Director of Isis-WICCE, we agree to re-imburse Isis-WICCE the total expenses they would have incurred for our participation in the programme.

i) Nominee's Signature: .....................................................

Please print name:.........................................................

Signed this date:..........................................................



ii) In-Charge of sending group (Signature): ...............................

Please print name:...........................................................

This date:......................................................................

Place:...........................................................................



Official Stamp of the sending group:




..........................................





Terms and Conditions of Participation:

A group can participate in the Isis-WICCE Exchange Programme as a Sending Group: This should be a women's group, working actively around the issues of women, armed conflict and peace building. The group should be well organised and have regular programmes or meetings through which the experience of the Exchange Programme may benefit other women. The sending group should also have a clear commitment to the follow-up activities the participant will be assigned to do.

The group should also have an interest in human rights. The group will nominate an active, permanent member of staff to represent it as a participant in the programme.

The Isis-WICCE Exchange Programme Institute demands serious commitment for the whole duration of the programme. There is much to be gained from participating in the programme, but there is also much commitment from the sending groups, and the participants themselves. The support from the groups and the full cooperation of the participant are vitally important for the success of the programme.

The Exchange Programme's Institute takes place over an extended period of time, part of it away from home and in a different culture. The participants must, therefore, be open to a different way of life, different food and different weather. A positive attitude towards adapting to different circumstances, culture, food and people, is the best way of making the most of such a potentially rewarding experience. Only flexible women should be encouraged to apply.

There are also financial considerations to be taken into account, and considerations relating to medical insurance. Please read these carefully.

It is for this reason that there are agreements to be signed at the end of the form. Please consider carefully the commitment you are making before signing this form.

THANK YOU.