A. PERSONAL DATA 1.Full Name: 2.Family Name (Last Name, Surname) Only: 3.Employer/Organization: 4.Position/Title: 5.Business Address: (not to exceed 40 characters per line) 6.Business Telephone: 7.Fax (if any): 8.Email address (if any): 9.Home Address: (not to exceed 40 characters per line) 10.Home Telephone: 11.At which address would you like to receive your mail? __ Business __ Home 12.Which phone number do you prefer we call? __ Business __ Home 13.Date of birth (day/month/year): 14.Nationality: 15.Name as it appears on passport or other travel document: 16.Passport number: 17.Country issuing passport: 18.Knowledge of English: Please rate your knowledge in these categories: Listening/Comprehension None Fair Good Excellent Reading None Fair Good Excellent Speaking None Fair Good Excellent Writing None Fair Good Excellent B. INSTRUCTIONAL TRACKS Instructional track applied (Select only one track; the tracks will run in paralell): Track 1 Web-based Information Services Track 2 Working Online Track 3 Basic Course in Database C. TRACK-SPECIFIC QUESTIONS For All Applicants: 1. Do you have experience in using the following Internet services? Please qualify your experience using 0 to 5, 0 means no experience and 5 a lot of expertise) [ ] Email [ ] Mailing List [ ] News [ ] FTP [ ] Web [ ] Other (specify): For applicants to Track 1: 1. Do you have experience running Web-based information services? (Please qualify your experience using 0 to 5, 0 means no experience and 5 a lot of expertise) [ ] Write HTML [ ] Provide information on a Web server maintained by others [ ] Set up, run and maintain Web servers [ ] Other (specify) : For applicants to Track 2: 1. Do you have experience participating and/or maintaining mailing lists? (Please qualify your experience using 0 to 5, 0 means no experience and 5 a lot of expertise) [ ] subscribing to a mailing list [ ] partipipating in an online discussion group [ ] facilitating an online discussion group [ ] running/maintaining a mailing list For applicants to Track 3: 1. Do you have experience using, designing and/or maintaining a database? (Please qualify your experience using 0 to 5, 0 means no experience and 5 a lot of expertise) [ ] using CDS/ISIS [ ] designing database [ ] supplying data/information to a database [ ] maintaining database 2.Please list the database software(s) you use in your organization D. DESCRIPTION OF ROLE IN ORGANIZATION/NETWORK's INFORMATION ACTIVES (Your answers to the questions below will be used to determine whether to admit you to the workshop. Please be sure that your information is sufficiently clear, well organized and adequate for this purpose.) 1. A summary of your relevant educational and professional background. 2. A description of your current employer/organization, your position, your duties and responsibilities. 3. A brief description of your computing and networking environment (operating systems, networking software, modems, etc.), including the connectivity of your organization to the Internet. 3a. Scope of your institution (check all categories that apply): Local Community National Regional Sub-regional Global Other; Specify 4. Does your organization use information and communication technology? How? 5. In 2-3 paragraphs, please describe your organization's plans vis-a-vis the use of information and communication technology (Internet services, database) in its information, networking and advocacy activities. 6. How you expect to use the knowledge you gain at the workshop. 7. Have you previously attended Internet-related training? Yes No If yes, 7a. Year and type of training: 7b. Did you find it useful? In what way? E. FINANACIAL INFORMATION You MUST fill out the following financial information. The actual cost of the workshop is ______. Participants are asked to pay US$300 registration fee to cover a portion of the actual cost. AWORC has been able to raise fund to support international travel cost for a limited number of participants. We encourage interested applicants to raise the registration fee and part or all of the international travel cost. 1. Will you be able to provide your own airfare? Yes No 2. Will you be able to provide your registration? Yes No 3. Will you be applying for scholarship/subsidy? Yes No 4.List the agencies where you are requesting financial aid, how much, and when you exepect them to reply. Agency Requested Amount Date U.S.$ F. HOW TO APPLY APPLICATION CAN BE DONE VIA WEB, EMAIL, FAX OR POST. 1. If applying via WEB, please fill up application form in http://www.women.or.kr/~went2000/apply 2. If applying by ELECTRONIC MAIL, copy and paste this questionnaire on your email message. Please use plain text, no attachments. The "Subject" line of the message should contain your surname or family name in the following format: Subject: WENT2000 Application: Applications submitted electronically should be sent to: went2000-apply@isiswomen.org 3. If applying by FAX or POST, print and fill up this questionnaire and send to: (post) WENT2000 c/o Isis International Manila 3 Marunong St., Diliman, Quezon City 1100 Philippines (fax) Facsimile: 632-924-1065 Attn: WENT2000 4. To get more information, visit: http://www.jca.apc.org/aworc/went2000 or email went2000@isiswomen.org.