With support from:
APPLICATION FORM
Improving the Governance of Extractive Industries
Asia Pacific Knowledge Hub Training Course
Thank you for your interest in the second batch “Improving the governace of EI” organized by the Department of Politics and Government, FISIPOL UGM (JPP) with support from Revenue Watch Institute (RWI) and USAID.
To apply, please fill out all fields below and send to , , with subject format:
ASPAC#2 April 2014 Training by February 27, 2014
Along with the application, please provide:
1. An essay (no more than 750-1000 words) responding to these following questions:
a. Why do you want to participate in this course?
b. How important it is and how it relates to your current job/activity?
c. What is your action plan after the course/the projection of implementing what you have gained from the course with your institutional needs?
2. Latest version of your Resume/CV
3. Letter of commitment
4. A letter from your employer in support of your application, which also describes the organization’s work related to the extractives industries
5. A passport size picture
6. Copy of English Proficiency certificate
Personal Information
Name:______
First Middle Last
Mailing Address:
Street
City State Country PostalCode
Email: Phone: Skype ID:
Date of Birth: Country of Birth: ______
Citizenship: Passport Number:______
Institution Information
Name of Institution :
Mailing Address:
Street
City State/Province Country PostalCode
Fax: Phone: Position: Years with Org:
Background Information
Highest Level of Education: ______
Major: ______
List trainings you have taken related to extractive industries (include topic, date, and location):
List trainings you have taken related to activism, NGO management, or research (include topic, date, and location):
______
How did you know about this training?
English Proficiency
Type of Test Score Date Taken
TOEFL:
ITP/Paper Based Test ______
Internet Based Test ______
IELTS ______
Other (Please Mention)
______
There will be 30 participants joining this training course on April 2014, 20 scholarships are available on the program fee. Please indicate if you are applying for scholarship
YES NO
All candidates will be assessed in an open and competitive selection process during the following IMPORTANT DATES:
· Application deadline : February 2014
· Announcement of shortlisted candidates : March 4, 2014
· Interview Via Skype (only for scholarship candidates) : March 7-8, 2014
· Final announcement : March 11, 2014
· Registration : March 12 – 16, 2014
Please sign the following before submitting your application!
I have read and understand the information above and am ready, willing and able to take on the responsibilities of Asia Pacific Knowledge Hub Training Alumni.
Signature:______
Date:______