A. General information

1 Name and acronym of the organisation in English:

2 Address of the organisation's Headquarters:

Street

Town/City

Postcode

Country:

Telephone:

Fax:

E-mail:

Internet site:

3 Year of establishment:

4 Type of organisation:

5 Organisational structure:

President and/or Secretary General of organisation: name, surname, address:

Structure and functioning of the organisation:

Staff

Number of members

6 Funding:

o Membership fees

o Public funding

o Private donations

o Other: please specify

7 Aims:

Please describe briefly the aim of your organisation:

8 Activities of your organisation:

9 Publications/journals:

Titles/number (per year/print run):

Does your organisation publish an annual report?

yes o no o

Does your organisation publish an annual work programme?

yes o no o

Does your organisation participate in EU practical cooperation measures/training/academic activities?

yes o no o

If yes, please mention which ones

Does your organisation produce a list of available publications related to the work of the EASO?

yes o no o

Please list other publication(s)/journal(s) that are most typical of your activities:

10 Geographical representation:

Please indicate the level at which your organisation is operating (local, regional, national, European and International):

B. Areas of possible co-operation with the EASO

Please indicate the areas of your organisation's activities which could be relevant to the different aspects of the work of EASO:

C. Modalities of co-operation with the EASO

Please indicate the preferred modalities of co-operation of your organisation with EASO:

o Participation in the Consultative Forum plenary meetings

o Expert meetings

o Internet consultations

o Others, please specify:

Name and Signature

Your position in the organisation

Date

Please enclose the following documents to support your application to participate in the EASO Consultative Forum

P the statute of your organisation

P a list of member organisations (if applicable)

P a report on recent activities

European Asylum Support Office, MTC Block A, Winemakers Wharf, Grand Harbour Valletta, MRS 1917, Malta — Tel: +356 22487500 4/4