Africa Regional Sexuality Resource Centre
2015 SEXUALITY LEADERSHIP DEVELOPMENT FELLOWSHIP
July 12- 25, 2015
APPLICATION FORM
The Africa Regional Sexuality Resource Centre’s Sexuality Leadership Development Fellowship (SLDF) is an annual two-week residential course which addresses contemporary issues and emerging best practices in policy and programming for sexual well-being in Africa. The curriculum will focus on sexuality, sexual health and rights, sexual diversity, pleasure, HIV/AIDS and vulnerabilities, gender and violence against women.
Deadline to apply: April 30, 2015
Guidelines: Carefully read and ensure that all questions on this application form are answered. Once completed, attach the form along with a copy of your up-to-date resume/CV to a cover letter, and send by e-mail to
1. Full Names: ______
(Last) (First) (Middle)
2. Country of Residence:______Country of Origin: ______
Personal Information
3. Gender: Male: Female: Marital Status: Single: Married:
4. Date of Birth: ______Age: ______
Contact Information
5. Physical Mailing Address: ______
6. Telephone: ______
7. Mobile/Cell Phone: ______E-mail ____________
Professional Information
8. Profession:______
9. Current Position:______
10. Organization/Institution:______
11. Address:______
12. Telephone:______
13. E-mail: ______Website: ______
14. Educational Background
Year / Institution / Country / Degree(s) Obtained/Specialization15. a) Explain why you want to take this course and how you expect it would contribute to your professional and personal development (200 words or less).
b) Describe your professional interests and your work. Have you worked on issues of sexuality, gender, sexual health and/or rights before now? (200 words or less).
c) How did you receive information about the SLDF Programme?
d) Please give the names of two professional or academic referees who know you and your work well
i. Name:
Organization/Position:
Mailing Address:
Telephone: E-mail:
ii. Name:
Organization/Position:
Mailing Address:
Telephone: E-mail:
16. Commitment to Full Participation and Payment of Costs
a) Full Participation
The Sexuality Leadership Development Fellowship will be held in Lagos, Nigeria from July 12 -25, 2015. Participants must commit to participating in the entire course including attending all sessions. Reading is completed during evening periods and films are shown at night.
I hereby confirm that I will participate in all aspects of the training programme. [ ]
Please tick or write yes in the box
b) Payment of Course Fees and Travel Cost
Participants are responsible for payment of the course fees and travel costs to and from the training programme.
I hereby confirm that I will be able to cover the course fees and my travel costs to and from the training programme [ ] Please tick or write yes in the box
17. Scholarships/Funding Sources:
There are no scholarships from the ARSRC this year. We therefore encourage you to begin approaching donors to sponsor your participation as soon as you submit application. Potential funding sources include the organization you work for, your organization’s donors (some funders will consider travel grants to current grantees) and agencies that fund sexual health and right issues.
Thank you for your interest in the ARSRC’s Sexuality Leadership Development Fellowship. Completed application forms and confirmation of funding are due on or before April 30, 2015. Applications received after this date may not be considered. Applicants will be informed about their acceptance by May 18, 2015.
Send all enquiries to:
The Course Director,
Africa Regional Sexuality Resource Centre (ARSRC)
17 Lawal Street, Off Oweh Street,
Jibowu, P.O.Box, 803, Yaba
Lagos, Nigeria.
E-mail:
Phone: Tel: + (234) -1-7743745, +234-80123445837
2
ARSRC 2015 Sexuality Leadership Development Fellowship (SLDF) Programme