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Application Form

MINDS Regional Civic Education Workshop in Elections and Governance
West Africa
4-5 December 2018
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Instructions
1. For any queries or if you are having trouble filling out and submitting the online form, kindly email dialogues@minds-africa.org before the application closing date.

2. Only submit your application once. Duplicate entries will be deleted.
                       
3. Please note that if you leave the webpage before clicking the 'Submit' button, all captured data will be lost.            
                       
4. Applications close at 12:00pm South African time on Wednesday, 17 October 2018.
Personal Information
Surname *
First name/s *
Age *
Date of birth *
MM
/
DD
/
YYYY
Gender *
Nationality *
Where are you currently based if different from home country?
Organisation you are representing *
Organisation you are representing *
e.g. Government, NGO, Private Sector, etc.
Occupation/ Designation/ Job title *
e.g. Student, Accountant, In between, etc.
How did you hear about the MINDS Civic Education Workshop?
If recommended by a person or an organisation, please provide the name.
Contact Details
Residential address *
Postal address *
Fixed line/ Day time telephone number *
e.g. +27113520501
Cellphone number *
e.g. +278123456789
Email address *
Please fill in your primary email address (only one email address).
Skype ID
Facebook name
Twitter handle
Individual Interests

Use a maximum of 350 words per response for each of the questions below.
a. Describe your responsibilities in your current role/s. *
Summarise the work/ activities that you are currently engaged in, including part-time activities you may be involved in.
b. What are your areas of interest in elections and governance and how have you been involved? *
c. Have you ever attended training in Civic Education, Citizenry or Elections and Governance? *
Specify the training you attended.
 If yes, please provide the name of the organization that provided the training.
Community Participation

Use a maximum of 350 words per response for each of the questions below.
a. Have you undertaken any volunteer work (current or past community activities)? If yes, please describe the nature of the work/ initiatives you have been involved in, the role/s you played and the impact of your work. *
Applicant Expectations

Use a maximum of 350 words per response for each of the questions below.
a. Why would you like to attend the MINDS Civic Education Training in Elections and Governance? *
b. How would the training assist you to work with youth in your community or country? *
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