Your Application must include all of the documents listed below:

?1. The completed Application Form (Part A completed by the Director of the Candidate’s organization; Part B completed by the Candidate)

?2. The Memorandum of Agreement duly signed by the Candidate and the Director of the Candidate’s organization

?3. Two supporting letters from national and/or international human rights organizations (other than the Candidate’s) familiar with the Candidate’s work and/or the work of his or her organization

?4. A brochure (and/or mission statement) describing the Candidate’s organization

CANDIDATE NOMINATED

Last (family) name (as it appears on your passport):

First name (as it appears on your passport):

Gender:

? Male ? Female

Work email (of the Candidate):

Personal email (of the Candidate):

Telephone:

Cell /Mobile phone :

Fax:

Home address:

Note: It is important to provide active email addresses, as it is the main method of communication

PART A: PROFILE OF CANDIDATE’S ORGANIZATION (to be completed by the Director of the organization)

1. Name of organization:

2. Name of Director:

3. Mailing address of the organization:

Number:

Street:

P.O. Box:

City:

Province/State:

Postal Code:

Country:

4. Telephone:

5. Fax:

6. Email (of the organization):

7. Email (of the Director):

8. Website:

9. Year in which organization was established:

10. Number of staff: Full time Part time

11. Number of volunteers:

12. Please indicate the type of organization you work for:

? Local NGO or Community-Based Organization (CBO)

? National NGO

? International NGO

? National Institution (e.g., Human Rights Commission,
Ombudsman)

? Academic or Research Institution

? Government

? Other, please specify

ACTIVITIES

13. Please list your organization’s three (3) main areas of activity (in order of priority) and identify the thematic focus of each one (e.g. HRE in schools, monitoring of minority rights, advocacy for women’s rights)

1.

2.

3.

ACTIVITIES (cont’d)

14. Please describe three (3) Human Rights Education activities undertaken by your organization.

Activity 1

Title:

Year:

Duration:

Goal:

Target audience:

Type of activity: Workshop ? Publication ? Advocacy campaign ? Public event ? Other ? (please specify)

Description of activity (please include information about topics covered, objectives, methods used, etc.):

Role of Candidate in activity:

Was this activity evaluated? Yes ? No ?

If yes, please describe the evaluation process used before, during and after the activity:

Results of the activity:

Activity 2

Title:

Year:

Duration:

Goal:

Target audience:

Type of activity: Workshop ? Publication ? Advocacy campaign ? Public event ? Other ? (please specify)

Description of activity (please include information about topics covered, objectives, methods used, etc.):

Role of Candidate in activity:

Was this activity evaluated? Yes ? No ?

If yes, please describe the evaluation process used before, during and after the activity:

Results of the activity:

Activity 3

Title:

Year:

Duration:

Goal:

Target audience:

Type of activity: Workshop ? Publication ? Advocacy campaign ? Public event ? Other ? (please specify)

Description of activity (please include information about topics covered, objectives, methods used, etc.):

Role of Candidate in activity:

Was this activity evaluated? Yes ? No ?

If yes, please describe the evaluation process used before, during and after the activity:

Results of the activity:

Expected benefit to the organization

15. Please describe how your organization would benefit from the Candidate’s participation in the IHRTP.

REFERENCES

16. References (Please list the names of national and/or international organizations that can be contacted if we have any questions about your organization). Please note that Equitas may contact the references listed, therefore please provide complete information.

Organization

Contact person

Telephone/Fax

Email

PART B: PROFILE OF CANDIDATE (To be completed by the Candidate)

17. Last (family) name:

First name:

18. Job title within your organization:

19. Status: ? Staff ? Volunteer

20. How long have you been working with this organization?

21. Description of overall responsibilities:

22. Describe your responsibilities in the Human Rights Education activities undertaken by your organization (e.g. developing human rights training material, facilitating training sessions):

23. Where did you hear about the International Human Rights Training Program?

EXPERIENCE

24. Please describe your past and present involvement with human rights (other than in your current organization):

Dates

Organization

Responsibilities

25. Please list any Human Rights Training Programs you have attended.

Year and length

Location

Host organization

Name of the Program

26. Education (start with last institution attended):

Name of institution and place of study

Years of study

Major fields of study

Degree

LANGUAGE

27. Preferred language of instruction: ? French ? English

28. Language proficiency in English (Please check the appropriate level):

Ability to understand

Ability to speak

Ability to read

Understand without difficulty ?

Speak fluently and accurately ?

Read fluently ?

Understand almost everything ?

(if addressed slowly)

Speak intelligibly ?

(but not always accurate)

Read slowly ?

Require a lot of translation and ? repetition

Speak with difficulty ?

(often looking for words)

Read with difficulty ?

(needs dictionary)

Expected benefit to the candidate

29. Please explain how you will personally benefit from your participation in the IHRTP:

PARTICIPATION FEE

30. A) The participation fee is 5,650$ CAD (this amount does not include travel expenses). Will your organization financially support your participation?

? Yes ? Partially ? No

If your organization can partially support your participation, please specify the amount of this contribution:

B) Can your organization cover your travel costs?

? Yes ? Partially ? No

If your organization can partially cover your travel costs, please specify the amount of this contribution:

31. Do you wish to be considered for a bursary? ? Yes ? No

If no, please indicate the name of the organization that will financially support your participation:

Personal information (for accommodation, visa and insurance purposes). Canadian applicants do not need to answer questions 32 to 37 inclusively.

32. Citizenship:

33. Passport number:

34. Passport delivery date (dd/mm/yyyy):

Day: Month: Please choose Year:

35. City of birth:

36. Passport city delivery:

37. Passport expiration date (dd/mm/yyyy)::

Day: Month: Please choose Year:

38. Date of birth (dd/mm/yyyy)::

Day: Month: Please choose Year:

39. Smoker: ? Yes ? No

40. Dietary restrictions: ? Yes ? No

If yes, please specify below at question 42 (e.g. Vegetarian/no pork/no beef)

41. Allergies: ? Yes ? No

If yes, please specify below at question 42 (e.g. food / animals / medication / other)

42. Special needs - Please state any special requirements with respect to diet, physical disability or religious/medical requirements:

Release of information

Note: Agreeing or not agreeing to any of these information sharing possibilities will NOT impact on the consideration of the application, which is assessed only according to the selection criteria identified in the Program Information Package.

Inclusion in the ‘Directory of Participants’

Each year, Equitas prepares and circulates an IHRTP ‘Directory of Participants’ to support the networking and collaborative efforts of civil society organizations, national human rights institutions, and government departments. The Directory includes the contact information and a short biographical note for each participant, facilitator and resource person and for their organization, as well as for Equitas staff and interns. Photographs are also included for those who agree. All IHRTP participants, Equitas staff and interns as well as facilitators and resource persons receive a copy of the Directory of Participants. However, Equitas recognizes that public release of personal information may carry risks for some human rights educators and activists. Inclusion in this Directory is subject to your express agreement; Equitas can assume no responsibility for misuse of this information by its recipients.

43. I agree to be included in the Directory of Participants ? Yes ? No

44. I agree to have my picture included in the Directory of Participants ? Yes ? No

Sharing information with other organizations

Equitas frequently receives requests for participant information from like-minded organizations (NGO’s, funding organizations, CIDA and international organizations) working to build a culture of human rights. Release of contact and organizational information, other than to funders of the IHRTP, is subject to your express agreement. Information is only shared where Equitas is of the opinion that doing so will assist participants and their organizations to make new contacts, to network, and to raise funds for their activities; however, Equitas can assume no responsibility for misuse of the information provided.

45. I agree that Equitas may share my contact and organizational information with outside organizations. ? Yes ? No