Application Form (Page 2/2)

EwhaGlobalEmpowermentProgram

Application Form

Deadline: April15, 2012

PLEASE TYPE OR PRINT IN ENGLISH.(Page 1/2)

PERSONAL INFORMATION

Surname

Firstname

Enter name exactly as it appears on passports or other official documents.

Address

City Postal code

Country

Telephone number (day, eve, mobile etc)

Date of birth (dd/mm/yyyy) Country of birth

E-mail Alternate e-mail

Country of residence Nationality

Resident registration # (Passport # for Int'l Student)

In case of emergency, please contact

Name Relationship with you

Address E-mail

Phone # () Fax # ( )Cell phone # ( )

Area Code Number Area Code Number Area Code Number

Indicate your knowledge of the languages listed below. Fill in the blanks with other languages you may know.

ENGLISHproficientfluent reading knowledge onlyspeaking knowledge only

KOREANproficient fluent reading knowledge onlyspeaking knowledge only

proficientfluent reading knowledge onlyspeaking knowledge only proficient fluent reading knowledge only speaking knowledge only

*Please note that all lectures, discussions etc. will be held in English. Also, the evaluation essay at the end of the program will have to be written in English by all participants.

ACTIVITIES

Professional experience

Organization or institution presently attending

Name / (Mother Tongue) / English
Address
Telephone / Homepage
Nature of Organization / NGO/NPO/INGO, Academia
Etc( ) / Year Established
Purpose Established
Brief Description
Position of Applicant
/ Work Period
Nature of Applicant's Work
Field of your organization
(Multiple choice) / ○Environment ○Family
○Fund Raising ○Gender Mainstreaming
○Media ○Labor
○Migration ○Reproduction/Health
○Sexuality
○VAW(DV, Sexual Violence, Sex trafficking) / ○Welfare
○Women Empowerment
○Education
○Religion
○Politics
○Policy
○Youth
○Development
○etc. ( )

Interesting area

Please check for your area(s) interested. (*multiple choice)

○Environment○Family○Fund Raising

○Gender Mainstreaming ○Information/Media○Labor

○Migration○Reproduction/Health○Sexuality

○VAW○Welfare○Women Empowerment

○Education ○Religion○Politics

○Policy○Youth ○Development

○etc ( )

EDUCATION

Highest level of education you have completed

Ineducation Elementary School Middle School High SchoolBachelor’s Degree Master’s Degree Doctoral Degree Etc( )

Years attended / Institution / Degree/Major / Country

RECOMMENDATION

Name, phone/fax numbers and e-mail address of individual from whom you are requesting a letter of recommendation.

Name / Organization / Title / Phone/fax numbers / E-mail

APPLICANT’S SIGNATURE

I certify that all information in my application is my own work, factually true and honestly presented.

SignatureDate

Asian Center for Women’s Studies, Ewha Womans University

EwhaYeoDae gil 26, Seodaemun-gu, Seoul 120-750, S.Korea

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