application form local politcial leaders 4
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DESCRIPTIONApplication form Local Politcial Leaders 4
FOR OFFICIAL USE
Received application by administration:
Sign _____________________ Date __________________
Comment, see attached note
Local Political Leaders Capacitating Women in Politics
Inception workshop in spring 2016Training in Sweden in October 2016
APPLICATION FORM (Typewriting or block letters)
(name of applicant)
(name of nominating municipality/region)
To the programme Local Political Leaders
(When necessary/applicable)The Nomination is approved by (name of authorizing authority) ___________________________________________________ in accordance with local rules.
The Application should be submitted to the ICLD no later than January 31st, 2016.Applications received after this date will not be considered.
Documents sent my e-mail should be addressed:[email protected] and referring to ITP Application in the header Documents sent by courier service should be addressed:ITP - ApplicationSwedish International Centre for Local DemocracyHamnplan 1SE-621 57 Visby, Sweden
PERSONAL HISTORY1. Names as written in passport (underline name by which formally addressed)
2. Office address
4. Home address
7. Airport of departure for international travel
8. Sex Male Female Other
3. Telephone (office) (country code/area code)
5. Telephone (home) (country code/area code)
Enclosed copy of passport
Date of birth Day Month Year
9. Have you participated in any ITP (International Training Programme) in Sweden before?
Yes No Name of programme, year ____________________________________________________________
Type of organization
Local Government Regional Government
Description of your work, including your personal responsibilities
Do you hold an elected position?
Mayor Vice Mayor Councilor
Are you a member of a
Committee municipal/regional board
If yes, which: _____________________________________
State the name of your party:
Is your party currently in
How many years (in total) have you had an elected seat?
Computer knowledge (rate from 0 to 5, where 0 = no knowledge, 3 = normal user, 5 = expert)
Applications Word ____ Power Point ____ Excel ________
I have access to internet
No Yes If yes at work at home elsewhere
Enclosed description 1-2 pages including:
1) Background and explanation of the role and responsibility of the applicant.
2) Problem analysis and/or situation analysis.
3) Strategic issue identified, and which tools needed to grow as a leader.
ABILITY TO UNDERSTAND Understands without difficulty when addressed at normal rate
Understands almost everything, if addressed slowly and carefully
Requires frequent repetition and/or translation of words and phrases
ABILITY TO SPEAK Speaks fluently and accurately and is easily intelligible
Speaks intelligibly, but is not fluent or altogether accurate
Speaks haltingly, and is often at a loss for words and phrases
ABILITY TO WRITE
Writes with ease and accuracy Writes slowly and with only a moderate degree of accuracy
Writes with difficulty and makes frequent mistakes
READING ABILITY AND COMPREHENSION
Reads fluently, with full comprehension
Reads slowly, but understands almost everything Reads with difficulty, and only with frequent recourse to a dictionary
I do not have any infectious diseases (for example tuberculosis or trachoma) or any other illnesses which could present risks to persons that I will come in contact with.
I do not have any medical conditions which prevent me from carrying out training away from home.
I am in good health and enjoying full working capacity.
Information to all applicants according to the Swedish Personal Data Act:Upon confirmation that your application has been accepted, the personal information that you have given in this application will be used by the Programme Organizer in administering the programme. Your personal data will also be available to ICLD for internal use. The data will not be used for other purposes.
I certify that my statement in answer to the foregoing questions is true, complete and correct to the best of my knowledge and belief.If selected as a participant I undertake to spend the time during the period of the programme as directed by the programme management.
If you are selected, you vill be notified by e-mail. Please confirm your acceptance to attend by e-mail.
For information or questions regarding the programme, please contact:
Kristin EkstrmProgramme ManagerE-mail: [email protected]
ENGLISH LANGUAGE SKILLS
Sign: Date: Nominated: Country: The: The Nomination is approved by name of authorizing authority: Date_2: 1 Names as written in passport underline name by which formally addressed: Day: Month: Year: 7 Airport of departure for international travel: Name of programme year: If yes which: Description of your work including your personal responsibilities: Word: Power Point: Excel: fill_4: Comment 1: Comment 2: Comment 3: Comment 4: Date_3: Kryssruta1: Telephone: E-mail: Home address: Telephone home: Mobile phone: Office address: E-mail home: Nationality: Passport number: Female: Other: 9: Yes: No:
Passport Number: Political Yes: Political No: Vice Mayor: Mayor: Councilor: Committee: municipal/regional board: Majority: Opposition: How many years: Other organization: Local Government: National Government: Other Government: Regional Government: Name of Party: Internet No: Internet Yes: Internet at work: Internet at home: Internet Elsewhere: Enclosed Description: Male: Understand almost everything: Understand repetition: Speaks fluently: Speaks intelligibly: Speaks haltingly: Reads fluently: Reads slowly: Reads with difficulty: Writes whit ease: Writes slowly: Writes with difficulty: infectious diseases: Medical conditions: Understand without difficulty: In good health: