application form local politcial leaders 4

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FOR OFFICIAL USE Received application by administration: Sign _____________________ Date __________________ Comment, see attached note Local Political Leaders – Capacitating Women in Politics Inception workshop in spring 2016 Training in Sweden in October 2016 APPLICATION FORM (Typewriting or block letters) Nominated ____________________________________________________________________________________________ Country ______________________________________________________________________________________________ The _________________________________________________________________________________________________ (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. Date _____________________ The Application should be submitted to the ICLD no later than January 31 st , 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 - Application Swedish International Centre for Local Democracy Hamnplan 1 SE-621 57 Visby, Sweden

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Application form Local Politcial Leaders 4

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  • 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)

    Nominated ____________________________________________________________________________________________

    Country ______________________________________________________________________________________________

    The _________________________________________________________________________________________________

    (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.

    Date _____________________

    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

    6. Nationality

    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)

    Mobile phone

    Passport number

    Enclosed copy of passport

    Date of birth Day Month Year

    E-mail (obligatory)

    E-mail (home)

    9. Have you participated in any ITP (International Training Programme) in Sweden before?

    Yes No Name of programme, year ____________________________________________________________

    POLITICAL RECORD

    Type of organization

    Local Government Regional Government

    National Government

    Other _________________________________________

    Description of your work, including your personal responsibilities

    Do you hold an elected position?

    Yes No

    Are you

    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

    Majority Opposition

    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

    Strategic issue

    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.

    Photo

  • 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

    MEDICAL STATEMENT

    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.

    Comment: ___________________________________________________________________________________________

    ____________________________________________________________________________________________________

    ____________________________________________________________________________________________________

    ____________________________________________________________________________________________________

    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.

    Date ___________________________________

    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: