WLR Visiting Professionals Program

Application Form - 2012

CONTACT INFORMATION

First Name Click here to enter text.	Last Name Click here to enter text.
Country of Citizenship Click here to enter text.	Date of Birth Click here to enter text.	Sex Click here to enter text.
Street Address Click here to enter text.
City Click here to enter text.	Country Click here to enter text.	Postal Code Click here to enter text.
Phone Click here to enter text.
Email Address Click here to enter text.
How did you hear about the Visiting Professionals Program? Click here to enter text.

PROFESSIONAL EXPERIENCE

Please tell us about your current job(s)

1. Organization’s Name Click here to enter text.
Organization’s Address, City, Country, Phone, Email Click here to enter text.
Current Title Click here to enter text.	Date of Employment Click here to enter text.	Supervisor’s Name Click here to enter text.
Brief description of current responsibilities Click here to enter text.
2. Organization’s Name Click here to enter text.
Organization’s Address, City, Country, Phone, Email Click here to enter text.
Current Title Click here to enter text.	Date of Employment Click here to enter text.	Supervisor’s Name Click here to enter text.
Brief description of current responsibilities Click here to enter text.

Please tell us about the most relevant jobs you have previously held

1. Organization’s Name Click here to enter text.
Organization’s Address, City, Country, Phone, Email Click here to enter text.
Job Title Click here to enter text.	Date of Employment Click here to enter text.	Supervisor’s Name Click here to enter text.
Brief description of your responsibilities Click here to enter text.
2. Organization’s Name Click here to enter text.
Organization’s Address, City, Country, Phone, Email Click here to enter text.
Job Title Click here to enter text.	Date of Employment Click here to enter text.	Supervisor’s Name Click here to enter text.
Brief description of your responsibilities Click here to enter text.
3. Organization’s Name Click here to enter text.
Organization’s Address, City, Country, Phone, Email Click here to enter text.
Job Title Click here to enter text.	Date of Employment Click here to enter text.	Supervisor’s Name Click here to enter text.
Brief description of your responsibilities Click here to enter text.

EDUCATION – Please list any formal studies that you have done

Secondary School

Name of Institution Click here to enter text.	City Click here to enter text.	Country Click here to enter text.	Years attended Click here to enter text.	Graduated? Click here to enter text.

Post - Secondary Studies

1. Name of Institution Click here to enter text.	City Click here to enter text.	Country Click here to enter text.	Years attended Click here to enter text.	Degree Earned Click here to enter text.
2. Name of Institution Click here to enter text.	City Click here to enter text.	Country Click here to enter text.	Years attended Click here to enter text.	Degree Earned Click here to enter text.
3. Name of Institution Click here to enter text.	City Click here to enter text.	Country Click here to enter text.	Years attended Click here to enter text.	Degree Earned Click here to enter text.

Certificates or Other Courses

1. Name of Institution Click here to enter text.	City Click here to enter text.	Country Click here to enter text.	Year Click here to enter text.	Degree Earned Click here to enter text.
2. Name of Institution Click here to enter text.	City Click here to enter text.	Country Click here to enter text.	Year Click here to enter text.	Degree Earned Click here to enter text.

ESSAY QUESTIONS - Please answer the next few questions in 2 or 3 paragraphs each.

1. Women’s land rights: Why are you interested? What have you done? Click here to enter text.

2. Tell us about a challenge that you have experienced working in development and what you have done to overcome it. Click here to enter text.

3. Why do you think the Visiting Professionals Program is right for you: What can you gain? What experiences and/or skills can you contribute? Click here to enter text.

4. The Program expects that Visiting Professionals will implement a project when they return home. Please give us one or two ideas of a project you might want to implement. Click here to enter text.

REFERENCES - Please list 2 references with whom we can get in touch

1. Name Click here to enter text.
Current Title Click here to enter text.	Organization’s Name Click here to enter text.
Contact Information: Address, City, Country, Phone, and Email Click here to enter text.
How do you know this person? Click here to enter text.
2. Name Click here to enter text.
Current Title Click here to enter text.	Organization’s Name Click here to enter text.
Contact Information: Address, City, Country, Phone, and Email Click here to enter text.
How do you know this person? Click here to enter text.

Signature: Click here to enter text. Date: Click here to enter text.