A. Personal Data
FULL NAME:
FAMILY NAME (LAST NAME, SURNAME) ONLY:
Employer/Organization:
Position/Title:
Business Address: (not to exceed 40 characters per line)
Business Telephone:
Fax (if any):
Email address (if any):
Home Address: (not to exceed 40 characters per line)
Home Telephone:
At which address would you like to receive your mail?
_____ Business _____ Home
Which phone number do you prefer we call?
_____ Business _____ Home
Date of birth (day/month/year):
Nationality:
Name as it appears on passport or other travel document:
Passport number:
Country issuing passport:
Knowledge of English: Please rate your knowledge in these categories:
Listening/Comprehension
None
Fair
Good
Excellent
Reading
None
Fair
Good
Excellent
Speaking
None
Fair
Good
Excellent
Writing
None
Fair
Good
Excellent
B. Internet Experience
1. Do you have experience in using the following Internet services?
Please qualify your experience using 0 to 5, 0 means no experience and 5 a lot of expertise)
[ ] Email
[ ] Mailing List
[ ] News
[ ] FTP
[ ] Web
[ ] Other (specify):
2. Do you have experience running Internet-based information services?
(Please qualify your experience using 0 to
5, 0 means no experience and 5 a lot of expertise)
[ ] Listserver
[ ] News server
[ ] FTP server
[ ] Web server
[ ] Searching/Indexing services
[ ] Other (specify):
C. Description of Role in Organization's Information Activities Your answers to the questions below will be used to determine whether to admit you to the workshop. Please be sure that your information is sufficiently clear, well organized and adequate for this purpose.
1. A summary of your relevant educational and professional background.
2. A description of your current employer/organization, your position, your duties and responsibilities.
3. A brief description of your computing and networking environment (operating systems, networking software, modems, etc.), including the connectivity of your organization to the Internet.
3a. Scope of your institution (check all categories that apply):
[ ] Local Community
[ ] National
[ ] Regional
[ ] Sub-regional
[ ] Global
[ ] Other
Specify________
3b. Approximate number of full time staff at your institution:
4. In 2-3 paragraphs, please describe your organization's plans vis-a-vis the Beijing Paltform for Action Review Process and Women 2000.
5. How you expect to use the knowledge you gain at the workshop.
6. Have you previously attended Internet-related training?
_____ Yes _____ No
If yes,
6a. Year and type of training:
6b. Did you find it useful? In what way?
7. Does your organization use information and communication technology? How?
E. Financial Information
You MUST fill out the following financial information.
You must pay US$300 registration fee for the training and boarding.
AWORC has been able to raise fund to support international travel cost for a limited number of participants. We encourage interested applicants to raise the registration fee and part or all of the international travel cost.
1. Will you be able to provide your own airfare?
[ ] No
[ ] Yes
2. Will you be able to provide your registration?
[ ] Yes
[ ] No
3. Will you be applying for scholarship/subsidy?
[ ] Yes
[ ] No
PLEASE SUBMIT BY ELECTRONIC MAIL IF POSSIBLE, using plain text, no attachments.
The "Subject" line of the message should contain your surname or family name in the following format:
Subject: WENT'99 Application: <last-name, first-name>
Applications submitted electronically should be sent to:
WENT-Apply@isiswomen.org
If you are not able to send your application by electronic mail, please return this application by fax or air mail to:
Asian Women's Resource Exchange
Isis International Manila
3 Marunong St., Diliman,
Quezon City 1100
Philippines
Voice: 632-435-3405
Facsimile: 632-924-1065