平成11年度海外婦人教育情報専門家情報処理研修事業応.docVIP

Application form for NGO applicant FY 2010 Empowerment Seminar for Women Leaders in the Asia Pacific Region This form must be filled out and signed by the applicant of non-governmental organization. The submission deadline is Monday 14 June 2010. Please type or PRINT.）The form should be submitted by email or fax. This form is available in MS Word format at: http://www.nwec.jp/English/ Official Name of Organization Abbreviated/Common Name Type of Service s Poverty Education training Health care services Armed conflicts Migration Decision making Advancement of women Human rights Media Environment Girl-child Other, specify: Address Phone Fax E-mail Web Site: http:// Year of establishment Staff composition by gender # of female staff: # of male staff: Name and Title of the representative Government office or ministry responsible for your organization No Yes Name: Periodical s No Yes Titles: Purpose of establishment, Mission statements Major achievements of your organization in the last five years Main funding source s and approximate size of funds in US dollars Date: Signature Form ２F Non Government 1