XIXth Feminist Capacity Building Course on Gender, Sustainable Livelihoods, Human Rights and Peace 14 September to 14 October, 2014,

TEWA Center, Kathmandu, Nepal Personal Information Sheet

Complete name (as in Passport): Date and place of birth: Parents names: Nationality: Passport number: Date and place of issue: Date of expiry: Complete address (Residence): Complete address (Official): Telephone number with STD/ISD code: Mobile number with STD/ISD code: Email address (Personal): Email address (Work): Fax number with STD/ISD Code: Any special needs in food, mobility etc.:

Application Form 1. Please list any training on Gender and Development you have received Name and Place of Training Dates /duration Themes Covered Facilitators

1.1 Have you ever attended or been part of any Sangat workshops, campaigns or events, please do share details? 2. Please list any trainings on Gender and Development you have facilitated Name and Place of Training Dates/ Duration Target group and no of participants Themes covered

3. Please do share some of the training tools and methodologies you use

4. What are your expectations or goals in attending this course?

5. Please do share specific areas of training where you would like to develop your skills in?

6. How would you like to contribute to this workshop? 7. Please send us a write up of your motivation for doing this course, and how you plan on using it in your work? (800 1000 words) References
List persons, not related to you, who are familiar with your work and qualifications. Please name two references:

1. 2.

Signature .

Date: .