yseali csdf application vietnam 2016

7/24/2019 Yseali Csdf Application Vietnam 2016

1/10

For official

use only:

__ __ x__ __ __ __

Official Application

Professional Fellows Program

Young Southeast Asian Leaders Initiative (YSEALI)Civil Society Development

Sponsored by the U. S. Department of State

Hosted by the Mansfield Center of the University of Montana

APPLICATION DEADLINE: 1 DECEMBER !1"

To su#$i% a&&lica%ion an' for $ore infor$a%ion( con%ac%:

Ngo Thu Hang, coordinator

Centre for Community Empowerment (CECEM)Apartment 0220, Buiding Hoa !hat

No" 2#$ %iai !hong &treet, Hanoi, 'ietnam(Ce) 0*00$+$ (Te) -++ * ++$0.0 (/a) -++ * ++$0.

thuhang"earning1cecem"org info"earning1cecem"org www"cecem"org

The 3EA45 !rofe&&iona /eow& !rogram i& a profe&&iona de6eopment echange program

for the 7e&t and 7righte&t community eader& from A3EAN, wor8ing in the fied& of ci6ic

engagement, ci6i &ociety de6eopment, economic empowerment, go6ernance, egi&ati6e

proce&&, en6ironmenta and natura re&ource& management" The 3EA45 !rofe&&iona /eow&!rogram pro6ide& participant& a month9ong feow&hip at :"3"97a&ed non9profit organi;ation&,

go6ernment office&, egi&ati6e 7odie&, or pri6ate &ector organi;ation&" /eow& wi wor8 with

community eader& to enhance their practica eperti&e, eader&hip &8i& and profe&&ionacontact& to addre&& i&&ue& in their home communitie&"

3EA45 i& !re&ident


2/10

1, BA.IC INFORMATION

Full na$e(eacty a&

it woud appear on

your pa&&port)>

/amiy Name>

/ir&t Name>

Midde Name>/en'er:

Mae /emae

Da%e of #ir%* (pea&e u&e the format of

year?month?day eampe> 20+??0)>A)e (eigi7iity i& 7etween the

age& of 2#9*#


3/10

, PROFE..IONAL E8PERIENCE

T*e 7oun) .ou%*eas% Asian Lea'ers Ini%ia%i0e is or)anie' aroun' four %*e$a%ic areas,

Please selec% %*e %*e$a%ic area %*a% $a%c*es your curren% 4or3 an' &rofessional )oals:

Ci6ic Engagement Economic Empowerment Education En6ironmenta 3u&taina7iity

Are you curren%ly e$&loye'6 e& No

5f ye&, do you wor8>/u9time !art9time

Do7 Tite> Name of empoying organi;ation>

3tart date at thi& empoyer(MM?)> Num7er of &taff you &uper6i&e>

Name of your &uper6i&or> 3uper6i&or emai>

or8 addre&&> City>

!ro6ince> Country>

!ea&e i&t a 7u&ine&& we7 addre&& if you ha6e one>

or8 teephone (incuding country?city code)>

or8 emai>

C*ec3 %*e ca%e)ory %*a% #es% 'escri#es your or)ania%ion:

Nationa go6ernment 4oca or regiona go6ernment 4oca non9go6ernmenta organi;ation

5nternationa non9go6ernmenta organi;ation Mutiatera organi;ation (e" :N) Media outet 4oca or nationa 7u&ine&& 5nternationa 7u&ine&& Educationa in&titution

C*oose %*e ca%e)ory %*a% #es% 'escri#es your or)ania%ion:Nationa capita


4/10

Pas% 4or3 ex&erience:

9, ED2CATIONAL E8PERIENCE

E'uca%ional Bac3)roun', !ea&e &pecify degree& and training, maor or fied of training, andyear degree of certificate competed"

olun%eer ex&erience an' $e$#ers*i&s in associa%ions or clu#s, !ea&e de&cri7e your current

6ounteer acti6itie&, incuding type of acti6ity, organi;ation affiiation, and genera time

commitment" !ea&e a&o de&cri7e any recent po&ition& of re&pon&i7iity hed with 6ounteerorgani;ation&"

4


5/10

;, INTERNATIONAL E8PERIENCE

+a0e you %ra0ele' %o %*e 2ni%e' .%a%es #efore6 e& No

If yes( *a0e you e0er o0ers%aye' %*e 'a%es allo4e' #y your 0isa e& No

If yes( &lease &ro0i'e infor$a%ion re)ar'in) your &as% %ra0el %o %*e 2ni%e' .%a%es, Thi&

&houd incude any tra6e to the :"3" for &choo, training, 7u&ine&&, or per&ona tra6e" !ea&e

pro6ide date&, rea&on for tra6e, and the type of 6i&a you tra6eed on" 5f you ha6e tra6epanned, 7ut ha6e not yet tra6eed, pea&e pro6ide that information a& we" !ea&e pro6ide the

&ource of funding for your trip" /or eampe, if you tra6eed to the :"3" for &choo, who

funded your &chooing

Da%e of

En%ry %o

2,.,

Da%e of Exi%

fro$ 2,.,

2,., isa

Ty&e

+os%

Ins%i%u%ion

Pur&ose of

Tra0el

Do you *a0e a &ass&or%6 5f &o,please attach a scan of the information page which incude&

your name and per&ona information"Pass&or% %y&e:

Ex&ira%ion 'a%e ( ?MM?@@)>

Are you a 2,., &er$anen% resi'en% or *ol' a )reen car'6 e& No

5


6/10

", EN/LI.+ LAN/2A/E .?ILL.

Please &ro0i'e an accura%e assess$en% of your En)lis* lan)ua)e &roficiency, High9e6e

proficiency in Engi&h i& reuired for thi& program" Mar8 an G in the 7o that corre&pond& withyour Engi&h anguage &8i& in the categorie& 7eow"

Reading Writing Speaing Listening

!omprehension

"ative

E#$ellent

%ood

Fair

Poor

Please 'escri#e any &rofessional or &ersonal 'u%ies or ac%i0i%ies %*a% you curren%ly con'uc%

in En)lis*,

Do you s&ea3 any o%*er lan)ua)es6 (5f &o, pea&e indicate fuency)

6


7/10

@, PROFE..IONAL PER.ONAL /OAL.( INTERE.T( MOTIATION

Please 4ri%e a s*or% #io)ra&*ic &ara)ra&*( 4ri%%en in %*ir' &erson( 4*ic* 4oul' #e use' in

&ro)ra$ $a%erials %o %ell o%*ers a#ou% you( s*oul' you #e c*osen for %*e &ro)ra$, Thi&paragraph &houd incude a &hort &ummary of your profe&&iona wor8, educationa 7ac8ground,famiy, and per&ona intere&t&" 5t &houd te peope a7out who you are and what i& important to

8now a7out you" Thi& paragraph woud 7e read 7y program officia&, your feow&hip ho&t, and

other& intere&ted in earning a7out the program (#0900 word&)"

Please ex&lain *o4 you *a0e *el&e' %o in%ro'uce a ne4 i'ea( ini%ia%i0e( or &ro'uc% a% your

or)ania%ion or co$&any( an' *o4 you a%%rac%e' su&&or% for i%, (#0 word& maimum)

7


8/10

Please 'escri#e a s&ecific c*allen)e in your co$$uni%y( or)ania%ion( in'us%ry( or coun%ry,

Inclu'e 4*a% you #elie0e %o #e %*e 3ey #arriers %o resol0in) %*is c*allen)e, (#0 word&

maimum)

Ta3in) %*e c*allen)e you 'escri#e' a#o0e( &lease 'escri#e %*e s%e&s you 4oul' li3e %o %a3e

%o a''ress %*is c*allen)e, Please ex&lain %*e s3ills an' resources %*a% you &ossess as 4ell as%*ose %*a% you 4oul' nee' %o ac5uire in or'er %o effec%i0ely a''ress %*is c*allen)e, (#0

word& maimum)

+o4 4oul' &ar%ici&a%in) in %*is &ro)ra$ i$&ac% your co$$uni%y an' en*ance your lon)

%er$ career )oals6 (2#0 word& maimum)

8


9/10

Please %ell us if you *a0e 'iscusse' %*is &ro)ra$ 4i%* your su&er0isor or collea)ues( an' if

your or)ania%ion *as a)ree' %o your &ar%ici&a%ion in %*e &ro)ra$ an' your a#sence for

%*e fi0e4ee3 len)%* of %*e &ro)ra$ in %*e 2,.,

Par% of %*is &ro)ra$ $ay re5uire you %o *os% a 2,., &ar%ici&an% in your or)ania%ion for

1!1" 'ays, Not e6ery A&ian /eow wi 7e a&8ed to do thi&, a& there wi 7e 2- A&ian /eow&and ony 09+ American /eow&" Howe6er, pea&e &tate whether your 7u&ine&& or organi;ation

woud agree to ho&t a :"3" participant in your fied" There i& no financia &upport reuired 7y

your organi;ation, a& a epen&e& woud 7e paid for 7y the program" The :"3" /eow woudpotentiay tra6e to A&ia in Augu&t 20. or Danuary 20$, &o pea&e note whether thi& woud 7e

an accepta7e time for your organi;ation to ho&t an American epert"

If you are c*osen for %*is &ro)ra$( you 4oul' ei%*er %ra0el %o %*e 2. fro$ a&&roxi$a%ely

May ; =une 1!( !1@ or Oc%o#er 19 No0e$#er 1( !1@,


10/10

If you are c*osen for %*is &ro)ra$( you 4ill #e &lace' in a fello4s*i& for ; 4ee3s 4i%* a

non&rofi% or)ania%ion or si$ilar or)ania%ion %o yours in Missoula( Mon%ana, !ea&e

de&cri7e the type of organi;ation you woud i8e to 7e paced with to maimi;e your earningo7ecti6e&" Thi& i& 6ery important to hep u& under&tand the wor8 that you do, the wor8 you

woud i8e to earn a7out, and your &pecific moti6ation for oining thi& feow&hip program" e

&ugge&t that you do &ome internet re&earch on organi;ation& in the city of Mi&&oua and ma8e&pecific &ugge&tion& to &trengthen your appication"

I 4is* %o oin %*e 7.EALI Ne%4or3 %o access 0ir%ual resources an' ne%4or3in)

o&&or%uni%ies for youn) .ou%*eas% Asian lea'ers, e& No

+o4 'i' you learn a#ou% %*e 7.EALI Professional Fello4s Pro)ra$6

:"3" Em7a&&y :"3" 3tate @epartment we7&ite 5nternet &earch !rofe&&iona i&t&er6 or new&etter

4oca pre&& (T', radio, new&paper) 3ocia media &ite (/ace7oo8, Twitter, etc")

Fecommendation 7y a coeague?partner organi;ation (name of coeague?organi;ation)>

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

ali'a%in) A&&lica%ion

5 certify that the information gi6en in thi& appication and a attached materia& i& compete and

accurate to the 7e&t of my 8nowedge" 5n &igning thi& appication 5 certify that 5 am not anempoyee, &pou&e, or a dependent of an empoyee of (!rogram Agency) or the :"3" @epartment

of 3tate" 5 under&tand that in addition to the &eection proce&& outined in thi& appication, the

fina deci&ion of my appication and my &tatu& a& a 3EA45 !rofe&&iona /eow i& contingentupon program funding, on the a7iity of (!rogram Agency) to pace me at an appropriate :"3"

organi;ation, and on my a7iity to recei6e and maintain a D9 6i&a to the :nited 3tate&" 5f

&eected a& a 3EA45 !rofe&&iona /eow finai&t, 5 agree to a7ide 7y the &tipuation& of the D9

6i&a reuirement&, and 7y a program reguation&, and to return to my home country for aminimum of two year& upon competion of the 3EA45 !rofe&&iona /eow& !rogram"

________________________________________ ______________________________

.i)na%ure Da%e

10

yseali csdf application vietnam 2016

Documents