Expression of Interest to Participate in the Third Meeting Of

APPLICATION FORM

Expression of interest to participate in the third meeting of

the Eastern Partnership Civic Society Forum (28-30 November 2011, Poznan, Poland)

Organization name and its legal status

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Название организации, ее правовой статус*

Short presentation of your organization (max. 100 words)

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Краткая информация об организации (макс. 100 слов)*

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Location (underline please)
EaP country
EU member state
International organization, network
Third country

Main sources of funding

* This information will be used for preparing some Russian language materials for CSF meeting in Poznan.

Main spheres of activity (choose max two and underline, please)

1 / Media, freedom of expression and freedom of information / 8 / Public policy, society development
2 / Education, research / 9 / Business, entrepreneurship, economic issues
3 / Health care, social services / 10 / Social dialogue and social partners
4 / Environment, energy / 11 / Community base, municipal and local activities
5 / Human rights, democracy, rule of law / 12 / Youth, family and gender issues
6 / Charity, religion / 13 / Culture, recreation
7 / Professional associations / 14 / Other (please, specify)………………………………………………

Which working group of the CSF would you like to participate in? (choose only one and underline, please)

1 / Democracy, human rights, good governance and stability
2 / Economic integration, convergence with EU policies
3 / Environment, climate change and energy security
4 / Contacts between people

Which sub working group at the CSF would you like to participate in? (tick, please)

№ / Sub working group / First choice / Second choice
1 / Free movement of people (visa liberalization)
2 / Public administration reform
3 / Anti corruption
4 / Media
5 / Judiciary reform
6 / Social rights and social dialogue
7 / Economic integration
8 / Energy Security
9 / Climate Change and Environment Protection
10 / Culture
11 / Volunteering
12 / Other (please, specify)

Is there a project idea/initiative[1] from your organization that could be proposed to the sub working group and what is its regional dimension? (max. 70 words)

Participation in the previous Forum’s meeting (tick, please)

Yes
If yes, which year (s) ...... / No

Has your organization been involved in any activities related to cooperation between EaP countries and the EU? If yes, please indicate the most important initiatives (max. 100 words).

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Describe the capacity of your organisation to act as a multiplier in generating debate and disseminating information on EaP-relevant issues (max. 100 words).

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Please, explain why your organization is interested in participation in the SCF 2011 meeting (influence, opportunities, involvement and experience in this sphere, etc.). How can you be engaged in the work of the Forum and what will it bring to your organization? (max. 100 words)

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Full name and signature of the applicant on behalf of the organization:

Contact phone:Contact e-mail:

Completed APPLICATION FORM should be sent to the official e-mail address of the EaP Civil Society Forum: not later than June 26, 2011 at 17.00 CET.

Personal data protection

Expression of interest in the Eastern Partnership Civil Society Forum will involve the treatment by the European External Action Service (EEAS) of personal data concerning the participant, in accordance with Regulation (EC) No 45/2001.

By completing the form above, the applicant will be considered as having given his or her consent to the processing of these data in the context of this invitation andthe Eastern Partnership Civil Society Forum’s activities. This contact information might be later distributed among the participants of the EaP Civil Society Forum, unless invited participants object to the publication of their contact details. The list of CSOs which applied to participate and the list of CSOs which were invited could be put on the website.

Purpose of the processing operation: all handling needed for the applicant’s eventual participation in the Eastern Partnership Civil Society Forum and drafting a global list of participants which might be distributed at the Forum.

Identity of data controller:European External Action Service (EEAS)

Right of access: Applicants have a right to access their data.

Third meeting of the Eastern Partnership Civic Society Forum, 28-30 November 2011, Poznan

[1]For a list of project activities, gathered in January 2011 in a survey of CSF participants, see: