Application Form
A. PERSONAL DATA
1.Full Name:
2.Family Name (Last Name, Surname) Only:
3.Employer/Organization:
4.Position/Title:
5.Business Address: (not to exceed 40 characters per line)
6.Business Telephone:
7.Fax (if any):
8.Email address (if any):
9.Home Address: (not to exceed 40 characters per line)
10.Home Telephone:
11.At which address would you like to receive your mail?
__ Business
__ Home
12.Which phone number do you prefer we call?
__ Business
__ Home
13.Date of birth (day/month/year):
14.Knowledge of English: Please rate your knowledge in these categories:
Listening/Comprehension Poor Fair Fluent
Reading Poor Fair Fluent
Speaking Poor Fair Fluent
Writing Poor Fair Fluent
B. COURSE-SPECIFIC QUESTIONS
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 Groups
[ ] World Wide Web
[ ] Search engines
[ ] Portals/directory Services
[ ] Other (specify):
2. Describe how you use the Internet in your work, for education,
entertainment, communication and for other purposes.
3. Do you have experience in running Web-based information services?
(Please qualify your experience using 0 to 5, 0 means no experience and 5 a lot of expertise)
[ ] Write HTML
[ ] Provide information on a Web server maintained by others
[ ] Set up, run and maintain Web servers
[ ] Other (specify) :
4. What role do you play in preparing information for a website, for
publications or for other media?
Administration Implementation Support
a. writing/editorial
b. graphic design/layout
c. media work such radio/video
d. public relations and
e. information dissemination
5. Do you have experience participating and/or maintaining mailing lists?
(Please qualify your experience using 0 to 5, 0 means no experience and 5 a lot of expertise)
[ ] subscribing to a mailing list
[ ] participating in an online discussion group
[ ] facilitating an online discussion group
[ ] running/maintaining a mailing list
6. Describe your organization's policy and advocacy work and your role in these acitivites?
7. What services are you involved in at your workplace and what role do you play in these services?
(Indicate whether implementation, support, administration or management.)
a. Information disemination
b. Publication
c. Repackaging of information
d. Information and reference service
C. DESCRIPTION OF ROLE IN ORGANIZATION/NETWORK'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
Provincial
Regional
National
International
Others; Specify
4. Does your organization use information and communication technology? How?
5. In what way is the Internet useful for you and your organization?
In 2-3 paragraphs, please describe your organization's plans vis-a-vis the use of information
and communication technology (Internet services, database) in its information, networking
and advocacy activities.
6. What role do you play in your organization information and communication strategy?
7. How you expect to use the knowledge you gain at the workshop. Please answer in 3-4 paragraphs.
8. Have you previously attended Internet-related training?
Yes No
If yes,
9a. Year and type of training:
9b. Did you find it useful? In what way?
D. FINANCIAL INFORMATION
You MUST fill out the following financial information. Participants are required to
pay US$300 registration fee to cover a portion of the actual training cost.
AWORC has been able to raise funds to support international travel cost for a limited number of
participants. We encourage interested applicants to raise part or all of the international
travel cost.
1. Will you be able to provide your own airfare?
Yes No
2. Will you be applying for scholarship/subsidy?
Yes No
3.List the agencies where you are requesting financial aid, how much, and when you exepect them
to reply.
Agency Requested Amount Date
U.S.$
E. HOW TO APPLY
APPLICATION CAN BE DONE VIA EMAIL OR FAX.
1. If applying by ELECTRONIC MAIL, copy and paste the questionnaire on
your email message.
***Please use plain text, no attachments.***
The "Subject" line of the message should contain your surname or family
name in the following format:
Subject: WENT-PH Apply: last-name, first-name
Applications submitted electronically should be sent to:
went-ph-apply@womenshub.net
2. If applying by FAX, print and fill up the application form and send to:
Fax No.
Attn: WENT-PH APPLY
