ARMM PROJECT
Philippines Program Year 1
Bureau of Educational and Cultural Affairs,
US Department of State
Northern Illinois University-International Visitor Program-Philippines
Alumni Foundation, Inc.
MAJORITY-MINORITY RELATIONS IN THE PHILIPPINES:
RELIGION, EDUCATION, COMMUNITY AND POLITICAL PROCESS
1. Name: ____________________________________________________________________
(Family Name, Given
Name, Middle Name)
2. Complete Home Address: ______________________________________________________
____________________________________________________________________________
3. Cell phone
number: _________________________ 4. Email: _________________________
5. Business Address: ____________________________________________________________
____________________________________________________________________________
6. Mailing Address: _____________________________________________________________
____________________________________________________________________________
7. Age: _____
8. Gender: _______ 9. Birthday (month/day/year): ________________________
10.
City/Municipality of Birth: _____________________________________________________
11. Country of
Birth: _________________ 12. Country of Citizenship: _____________________
13. Occupation:
________________________________ 14. Civil Status: __________________
15. Do you
currently hold a Philippine __________ or other Nationality __________ passport?
16. Religion:
_________________________ 17. Ethnic Identity: _________________________
18. If married,
Name of Husband/Wife: _____________________________________________
19. Number and
Ages of Children: _________________________________________________
20. Name of
Parents: ___________________________________________________________
21. Parents’
Religious Affiliation: _________________ 22. Ethnic Identity: ___________________
23. Parents’ Address and Contact Numbers: __________________________________________
____________________________________________________________________________
24. Degree/s Completed: _________________________________________________________
_____________________________________________________________________________
26. Field/s of Specialization ________________________________________________________
_____________________________________________________________________________
27. Other
Training _______________________________________________________________
_____________________________________________________________________________
28. Membership in Professional Societies:
_____________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
29. Membership in other organizations (NGO, Civic, Church Related, list dates): ________________
_____________________________________________________________________________
_____________________________________________________________________________
30. Membership in Peace Related Organizations (list dates): ________________________________
______________________________________________________________________________
______________________________________________________________________________
33. Leadership Experiences: ________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
35. Employment
Record: ___________________________________________________________
______________________________________________________________________________
36.
International Work Experience: ___________________________________________________
______________________________________________________________________________
37. Consultancies: ________________________________________________________________
______________________________________________________________________________
38. Resource
Speakers/Lectures: ____________________________________________________
______________________________________________________________________________
39.
Publications: _________________________________________________________________
______________________________________________________________________________
40. Outstanding Accomplishments: ___________________________________________________
______________________________________________________________________________
41. Have you ever been to the United States of America on a grant from the US
State Department? If yes, please list date/s and program/s details.
______________________________________________________________________________
______________________________________________________________________________
42. References and Addresses: (at least three)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please write a 3 page essay about yourself and relevant experiences in peace-building and your role as a leader in strengthening the foundation of peace and development in Mindanao.
I hereby certify that the above information on the application form and the required documents are true to the best of my knowledge. I authorize the verification of any or all information listed above.
_____________________________ ________________________
(Signature of Applicant) (Date)
Instructions:
Please see to it that all information being asked from you in this application form are completely and truthfully answered. Do not leave any item unanswered. Incomplete entries and supporting documents will not be accepted. Place your completed form and essay in an envelope and submit it to your Local IVP Phils Coordinator not later than January 12, 2006 or to:
ATTY. MARILEN C. RAMIRO
IN-COUNTRY PROJECT COORDINATOR
INTERNATIONAL
VISITOR PROGRAM-PHILIPPINES
ALUMNI FOUNDATION. INC.
UNIT 1716 CITYLAND CONDOMINIUM 10 TOWER 1,
H.V. DELA COSTA ST., MAKATI CITY
For further inquiries:
Office Phone No: (02) 8402536 - Aviec or Melvin
E-mail: secretariat@ivp-phils.org.ph