APPLICATION FORM
Thank you for your interest in the fourth batch of training on “Coalition for Reform in Extractive Industry” organized by the Department of Politics and Government, FISIPOL, Universitas Gadjah Mada, with support from the Natural Resource Governance Institute (NRGI).

To apply, please provide documents as follow:

1. An essay (no more than 750-1000 words) responding to these following questions:
a. why do you want to participate in this course?
b. how important it is and how it relates to your current job/activity?
c. what are the policy reform areas in your countries?
d. how this training will support you to work on these policy reforms?
e. Who are potential actors that you will work with to advance these reforms?
f. What is the projection of implementing what you have gained from the course with your institutional needs?
2. Latest version of your Resume/CV
3. Letter of commitment
4. A letter from your employer in support of your application, which also describes the organization’s work related to the extractives industries
5. A passport size picture
6. Copy of English Proficiency certificate

send these documents to aspachub.polgov@ugm.ac.id The short list candidates will be interviewed by phone / skype. The deadline for the application is extended until November 30, 2016.

7. Please fill out all fields of application form below

For more information about our general conditions and the online application form, please email Mr Muhamad Djindan, Asia Pacific Hub Manager, at aspachub.polgov@ugm.ac.id

Email address
Personal Information
Name
Please write you full name by first, middle, last name
Your answer
Gender
Your answer
Citizenship
Your answer
Passport Number
Your answer
Country of Birth
Your answer
Date of Birth
Your answer
Mobile Number
Your answer
Email
Your answer
Skype ID
Your answer
Institution Information
Name of Institution/Organization
Your answer
Type of Organization
Mailing Address
Please specify street, city/province, country, postal code
Your answer
Office Phone and Fax Number
Your answer
Position in the Institution/Organization
Your answer
Years with Institution/Organizaiton
Your answer
Background Information
Highest Level of Education
Your answer
Major Study
Your answer
A Short Bio
Please give your short bio, including your position, task and responsibilities in your organization related to extractive industries
Your answer
List training you have taken related to extractive industries (include topic, date, and location):
Your answer
List training you have taken related to activism, NGO management, or research (include topic, date, and location):
Your answer
How did you learn about this training
Your answer
English Proficiency
Type of test
Please specify English proficiency test have you taken (TOEFL, IELTS or others) with the score and data taken.
Your answer
There will be 30 participants joining this training course on 9-20 January 2017, 10 scholarships are available on the program fee. Please indicate if you are applying for scholarship
Please sign the following before submitting your application
Please put your name below as the signature that you have read and understand the information above and are ready, willing, and able to take on the responsibilities of Asia Pacific Knowledge Hub Training Alumni
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A copy of your responses will be emailed to the address you provided.
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