APPLICATION FORM

5th Annual
International Leadership Training Programme:
A Global Intergenerational Forum
August 1 – 9, 2009

Home information:

Sur Name:
Full Name:
Home Address:
Street:
City:
State:		Zip Code:
Country:
Date of Birth:		mm /dd /yyyy	(Must be between ages 18-30)
Gender:	Male:	Female:

Languages spoken/fluency (native, fluent, comprehensive or basic):

Mobile:
Land Phone:
Email Address:

Work/Community Experience:

Name of Current Employer:
Contact Information of Employer:
Street:
City:
State:		Zip Code:
Country:
Telephone:

Volunteer/Community Activities:

Non-Governmental Organization with which you are affiliated (if applicable):

Name of Organization:
Name of Supervisor:
Telephone:
Address of NGO:
Street:
City:
State:		Zip Code:
Country:

Tertiary Education:

Name of Institution:
Address:
Street:
City:
State:		Zip Code:
Country:
Telephone Number:
Name of Advisor:
Graduation (Expected or Actual):

Please list any special skills or experiences that you feel may be relevant in the application process.

Names and Contact Information for Three Professional References:

Frist Reference:

Second Reference:

Third Reference:

Letter of Intent (required 750 – 1,000 words typed):
Please describe a) your reasons for applying to this program, b) your main fields of interests in the program, c) how you hope to benefit from the program, and d) the human rights issue of concern that you would like to address at the conference and when you return home.

Application Essay :
Forum participants should be advised that upon admission, they will be required to submit a human rights related essay.

Please click here for further details.

Attach Curriculum Vita/Resume

By checking this box, I certify that all personal, academic and residency information given on this application is complete and accurate. Failure to disclose accurately all facts relating to this application may be grounds for denial of acceptance, and/or dismissal from program. I understand that unless I specifically request otherwise, any photograph(s) taken of me at the conference may be used in print and electronic publications produced by the UNESCO Chair & Institute of Comparative Human Rights. I understand that if accepted into the leadership forum, I am required to attend all sessions and will participate in all activities and programs. Due to US Immigration policies, I will inform conference organizers of my travel plans in the United States following the fourm and before returning to my home country.

For Additional information:

If you have questions regarding the application/registration, program content, special needs requirements, or housing, please call the UNESCO Chair Office at 860-486-0647 or email unescochair@uconn.edu.

ALL applications must be submitted electronically or via facsimile no later than
February 27, 2009 to to unescochair@uconn.edu /fax: 860.486.2545

University of Connecticut
UNESCO Chair & Institute of Comparative Human Rights
233 Glenbrook Road, Unit 4124
Storrs, CT 06269-4124

860.486.0647 Phone
860.486.2545 Fax
www.unescochair.uconn.edu