Application form sep 2015 6th cifal jeju name [original]

Workshop Application Form

• Title: “Developing Capacities on Climate Change Adaptation (CCA) and Disaster Risk Reduction (DRR) in the Asia-­‐Pacific Region” • Date: 14 -­‐ 17 September 2015 (Mon-­‐Thu) • Place: Jeju, Republic of Korea (Jeju is an island located off the southern coast of Korea)

v Application forms and attachments should be submitted by email, to CIFAL Jeju Office at cifaljeju.jitc.1@gmail.com by Tuesday 28 July 2015 (with “2015 6th CCA & DRR Workshop Application” in the subject line) or fax them to +82-­‐64-­‐738-­‐4626.

PARTICIPANT NAME (Please type your name in capital letters as written in your passport.)

Gender (M/F) Nationality Postal Address (Office Address)

Contact Information (Country code + Regional code + Phone/Fax number) Organizational Affiliation (Choose one. Please specify the name of your organization in the space provided.)

Title Surname Middle name First name Position

Mr/Ms/Mrs/Dr/Others (please specify)

Date of Birth (yyyy/mm/dd) PO Box Street City Postcode Country E-­‐mail Office Phone Mobile Phone Fax Academia Government – National Government – Local Government – State Other Regional Organization UN/UN System UN/UN System (locally recruited)

Describe your work Reference (Please provide the name and address of your supervisor/the head of your organization/government.)

Name Position Contact details

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Are you sponsored by your organisation/government or from any other sources for your airfare, accommodation and other travel costs? (please specify) How did you learn about By mailed or faxed the event? announcement (Choose all that apply.)

By email By social networking (Facebook, Twitter, etc.)

By word of mouth By local press Other English Skills Ability to

Understand

Ability to speak fluently Ability to read Ability to write English Proficiency Test

Yes ( ) No ( )

Good ( ) Fair ( ) Poor ( ) Good ( ) Fair ( ) Poor ( ) Good ( ) Fair ( ) Poor ( ) Good ( ) Fair ( ) Poor ( ) TOEIC ( ) TOEFL ( ) IELTS ( ) Others ( )

Questionnaire

Needs Assessment for “Developing Capacities on Climate Change Adaptation (CCA) and Disaster Risk Reduction (DRR) in the Asia-­‐Pacific Region” ※ Please describe in as much detail as possible in your own words (maximum 250 words) below.

1. Are you familiar with the concepts of 'Climate Change Adaptation (CCA)’ and ‘Disaster Risk Reduction (DRR)’? If so, do you have any idea how to apply these concepts to your local context?

2. Does your country or city/municipality have an action plan or strategy for climate change adaptation and disaster risk reduction?

3. What are the common climate change related disasters or risks you face in your city/municipality or territory? And how do you commonly deal with these? (Give one example of a recent incident.)

4. Is your government engaged in any regional/international activities to address issues related to climate change and disaster risk?

5. Has your organization initiated activities to promote effective climate change adaptation and disaster risk reduction?

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6. Describe the three key challenges for your government in effectively preparing for natural disasters and mitigating risks from climate change.

1) 2) 3)

7. How do you intend to follow-­‐up with the action plans you will present at the training workshop?

County Information (maximum 2 pages in MS Word Format)

Please briefly write the situation of your country in terms of climate change adaptation and disaster risk reduction, including the information of which international conventions your country is party to, responsible national and regional organization, and policies.

Have you participated in a previous CIFAL event?

Yes No

(If yes, please specify)

Please write why you want to participate in this workshop and how your job is related to climate change adaptation and disaster risk reduction.

Please attach: 1. A Curriculum Vitae (maximum 2 pages) 2. Country Information (maximum 2 pages) 3. Letter of Nomination 4. Letter of Commitment

 APPLICATIONS WITHOUT THE ABOVE ATTACHMENTS WILL NOT BE ACCEPTED.

For general information please contact:

n UNITAR CIFAL Jeju/JITC 227-­‐24, Jungmungwangwang-­‐ro, Seogwipo-­‐si, Jeju-­‐do, Republic of Korea Phone: +82 (0)64 735 6582 Fax: +82 (0)64 738 4626

Email: cifaljeju.jitc.1@gmail.com

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LETTER OF NOMINATION

Organization name: _________________________________

Nominates the following person (name): __________________________________

to participate in the UNITAR CIFAL Jeju/JITC workshop, and certifies that:

___ all information supplied by the nominee is complete and correct; ___ the nominee has adequate knowledge of the working language of the training program (English); ___ the nominee, if selected, will participate actively and conscientiously in all the training activities provided by UNITAR CIFAL Jeju/JITC.

Applicant’s immediate supervisor (Name): ____________________________ (Position): ___________________________ Office telephone number: _________________________ E-­‐mail address: __________________________________

__________________________________

(Signature)

__________________________________

(Date)

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LETTER OF COMMITMENT

All parts of the above application form are true and verifiable. If I am selected to participate in the UNITAR CIFAL Jeju/JITC workshop, I will attend all its training activities, actively pursuing my project objectives and completing any assignments given related to the training program. I am aware that I have to submit a country information and, once selected, learn and apply the Making Cities Resilient (MCR) Tools, Diagnosis and Assessment and make City Action Plan during the workshop.

__________________________________ (Printed name)

__________________________________ (Signature)

__________________________________ (Date)

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