APPLICATION FORM: CSO Forum in advance of the Midterm Review of 2013 Asia Pacific Ministerial Declaration on Population and Development

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24-25 November 2018 in Bangkok, Thailand

SECTION ONE

Name of the Applicant (full name) *

Email of Applicant *

Job Title of Applicant *

Organization Name *

Organization Mission or Vision *

Organizational Website *

Does the Organization have ECOSOC status ? *

Yes

Passport Number of Applicant (for visa purposes)

Nationality of Applicant (for visa purposes)

Are you applying for a Scholarship to attend the Forum? *

Yes, I am requesting full support (flight, accommodation and DSA)

Yes, I am requesting partial support (accommodation and DSA only)

No, my organization will support my attendance

Are you also applying to attend the Midterm Review of the Asia Pacific Declaration on Population and Development (26-28 November)? *

Yes

SECTION 2

Which constituency does your organization represent? (please pick no more than 2) *

Women

Children, Young People and Adolescents

People Living With and Affected by HIV

LGBTIQ

Indigenous People

Migrants and Mobile People

People with Disabilities

Older People

People Affected by Conflict and Disaster

Other

Other:

Required

Geographical Coverage of the Organization *

If you are a national organization, please identify which country

If you are from a regional or sub-regional organization, please choose which region

Central Asia

East Asia

Southeast Asia

Oceania

Asia and the Pacific

Other:

Clear selection

If you answered "Other" on the questions above, please explain.

Please BRIEFLY explain which of the following key issues that you have expertise on: SRHR, Gender Equality, HIV, Human Rights, Migration, Aging, Youth, Climate Change, Conflict, Disasters *

Please specify which area of work you engage in: advocacy, service delivery, research or other; related to the above key issues (SRHR, Gender Equality, HIV, Human Rights, Migration, Aging, Youth, Climate Change, Conflict, Disasters ) *

Do you have any experience working with Government(s) on the key issues (SRHR, Gender Equality, HIV, Human Rights, Migration, Aging, Youth, Climate Change, Conflict, Disasters )? If yes, please BRIEFLY explain.

Please identify if your organization has any previous engagement in UN ESCAP processes - please list process and year (such as the 2013 Asia Pacific Population Conference, or the 2015 Asia Pacific Forum on Sustainable Development) *

Please explain if you have previously participated in any ICPD processes at national, regional, and/or international level. *

Do you expect to be included as a Member of a National Delegation? *

Yes

I'm not sure

If you answered yes to the question above, please identify which delegation:

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