APCD Training Courses > Training Courses 2003 > Non-Handicapping Environment Training > Appendix of Nomination From

APPENDIX OF APPLICATION FORM
for
Training Workshop on Capacity Building for Self-help Organizations of Persons with Disabilities

Please submit all pertinent documents and your answers to this questionnaire in typewritten form together with your Fellowship Application Form. **This appendix is available at http//www.apcdproject.org/training_sh_appendix.html

Download Application Form for Capacity Building for Self-help Organizations of PWDs in PDF format (103 KB)

APPENDIX OF APPLICATION FORM
FOR
Training Workshop on Capacity Building for Self-help Organizations of Persons with Disabilities

Please submit all pertinent documents and your answers to this questionnaire in typewritten form (page 5-9) together with your Fellowship Nomination Form.

TITLE Mr. Ms.

Mrs.
GENDER MALE

FEMALE

NAME (capital letter)
FAMILY NAME	GIVEN NAME	MIDDLE NAME

HOME ADDRESS:

TELEPHONE NUMBER (Country Code/Area Code/Number):
FAX NUMBER (Country Code/Area Code/Number):

E-MAIL ADDRESS:

NAME OF THE ORGANIZATION:

ADDRESS:

TELEPHONE NUMBER (Country Code/Area Code/Number):
FAX NUMBER (Country Code/Area Code/Number):

E-MAIL ADDRESS:

DISABILITIES ( IF ANY)

YES
NO

TYPE OF DISABILITIES:

ASSISTIVE DEVICES USED: YES NO
DETAILS OF ASSISTIVE DEVICES:

DIETARY REQUIREMENT (IF ANY)

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I hereby certify that the foregoing information is correct, accurate and complete to the best of my knowledge.

In the event that I suffer injury, illness or death during the course of my participation in the program/course, I shall hold the Royal Thai Government, the Government of Japan and/or the Asia-Pacific Development Center on Disability harmless and without any liability whatsoever for compensation towards myself, my legal representatives and/or my heirs. Should I cause any person loss of property, injury, illness or death during the course of my participation in the program/course, I shall be fully responsible and liable for the said person without reference whatsoever to the Royal Thai Government, the Government of Japan and/or the Asia-Pacific Development Center on Disability.

SIGNATURE OF NOMINEE ......................

PRINTED NAME OF NOMINEE ( )

DATE:

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Download Questionnaire for Capacity Building fof Self-help Organizations of PWDs in PDF format (44 KB)

Questionnaire

Q1 Do you see any difference between "an organization of persons with disabilities" and "an organization for persons with disabilities"? Please state the weakness and strength of those organizations.

Q2. Which do you prefer "a single-disability organization" or "a cross-disability organization"? Please state the weakness and strength of those organizations.

Q3. How do you explain the terms of "self-help" and "advocacy"?

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APPENDIX OF APPLICATION FORM for Training Workshop on Capacity Building for Self-help Organizations of Persons with Disabilities

Questionnaire

APPENDIX OF APPLICATION FORM
for
Training Workshop on Capacity Building for Self-help Organizations of Persons with Disabilities