Please fill in this form and send it via e-mail to the ENYA Secretariat to Cath Moss:


BACKGROUND INFORMATION:

FIRST NAME:

LAST NAME:
ADDRESS:
COUNTRY:
TEL MOBILE:

FACEBOOK PAGE URL:

SKYPE USER NAME:
EMAIL ADDRESS:
Female: YES NO

Roma: YES NO
DATE OF BIRTH (Year/Month/Date):

AGE:
COUNTRY OF PASSPORT:
If you need a visa please fill in the following:
NAME IN PASSPORT:
Country of passport:
Passport Number:
Date of Expiry:
Issued At:
MEMBER OF WHAT ORGANISATION / CHURCH / FAITH COMMUNITY / NGO / or PROJECT IF ANY:
Web Site Address:
WHAT IS YOUR INVOLVEMENT IN THE ORGANISATION (Experience, position and responsibilities)?:
PREVIOUS INTERNATIONAL TRAINING EXPERIENCES: Event – Organiser – Dates – Place
GENERAL INFORMATION QUESTIONS (answer all questions):
1. Write a short autobiography including your education, employment, training, volunteering, Church / Faith Community / NGO work and social project involvements.

2. How would you describe yourself? What are your hobbies, talents, passion, dreams and interests?

3. Why are you interested in participating in this programme?

4. How are young Roma women affected by social and economic injustices and exclusion in your community and country (in what ways, forms and situations)?

5. What do you believe are the most effective ways to reduce injustices and exclusion ofRoma Young Women?

6. Please prioritise which focus area is most important to you

– 1st is most important and 6th least important.
The main FOCUS areas of the seminar and the MICRO – PROJECTS (small grants programme) we will be implementing are:

____ Poverty and Unemployment

____ Education

____ Health and Access to medical Services and Support

____ Violence Against Young Roma Women

____ Young Roma Women’s Participation in Political and Public Life

____ Capacity Building, Leadership Training and Development of Youth Groups, Women’s Groups

or NGO’s

Any other comments or additions?

7. What abilities, special knowledge/experiences, or workshops could you share within the Programme? We would like to encourage all participants to lead a session on one of the FOCUS AREAS or related topics:
8. Please list any proposals that you might have for the programme?
9. Any other comments or special needs? (Vegetarian?, Access needs?, Health needs?, Other?)

FINANCES:

This section must be totally filled in or your application will be rejected!

I and/or my organisation will cover the full participation fee of 20.00EUR YES NO
(All participants need to pay the participation fee.)
Travel Costs
I and/or my organisation will cover all my travel costs. YES NO
If you answered NO to the question above, please complete the next section:
I would like to apply for a Scholarship towards my travel costs. YES

Method of travel

Please give all costs in local currency and in Euros.

TRAVEL COSTS in Euros: Local currency
VISA COSTS in Euros: Local currency
TOTAL COSTS in Euros:
I can contribute:
My organisation can contribute:
TRAVEL SCHOLARSHIP REQUESTED=
I confirm that I am a young Roma woman. YES NO

I attach with this application form:

MY CV and TWO REFERENCE LETTERS YES NO

Name:

Date: