2016 Roundtable Participant Application Form

Thank you for your interest in this event!

Please answer the questions in this survey with as much information as necessary and we will let you know the result of your application soon.

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* 1. Personal Details

First Name (Passport/ID)

Last Name (Passport/ID)

Preferred Name (if different)

Date of Birth

Age

Gender

Country of Residence

Mobile Number

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* 2. Member Organisation

I am representing an IGLYO Member Organisation

I am representing another organisation

I am applying as an individual

Organisation Name (if applicable)

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* 3. Do you require a visa to travel to Belgium? If you do, please answer Q4. If you do not, you can go to Q5)

Yes

No/I already have a valid visa

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* 4. If you require a visa, please fill in the following information:

Nationality

Passport Number

Date of issue (DD/MM/YYYY)

Place of issue

Expiry date (DD/MM/YYYY)

Occupation

Address of Embassy

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* 5. How well can you understand and speak English?

Fluent

Advanced

Average

Basic

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* 6. Please describe your experience (be it professional or personal) relevant to the topic of this event.

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* 7. Why do you want to participate in this event? What do you expect to get as a result of your participation?

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* 8. Please insert the link to your video message, as required in the call. It can be a link to wetransfer.com or other file sharing website. If you are sending it by email, please say so here.

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* 9. Please tell us what you think about the possibility to participate in the Ethnic Identity Conference (this will not be considered in the selection of participants but we would like to get an indication of how many people are interested and available).

I would like to be part of the preparatory team

I would like to participate in the conference, but not as a preparatory team member

I do not think I can attend the conference

Other (please specify)

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* 10. Please share with us any ideas or suggestions you might have for this event. This will not be considered in the selection of participants, but we certainly appreciate any input!

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* 11. Which of the previous IGLYO events have you applied for and/or attended?

	Not Involved	Applied (not accepted)	Attended
Standing Together Study Session (Mar 14, Budapest)	Standing Together Study Session (Mar 14, Budapest) Not Involved	Standing Together Study Session (Mar 14, Budapest) Applied (not accepted)	Standing Together Study Session (Mar 14, Budapest) Attended
Norm Critical Approaches in Education (Apr 15, Brussels)	Norm Critical Approaches in Education (Apr 15, Brussels) Not Involved	Norm Critical Approaches in Education (Apr 15, Brussels) Applied (not accepted)	Norm Critical Approaches in Education (Apr 15, Brussels) Attended
Intersectionality Roundtables (Apr - Sep 14, Brussels)	Intersectionality Roundtables (Apr - Sep 14, Brussels) Not Involved	Intersectionality Roundtables (Apr - Sep 14, Brussels) Applied (not accepted)	Intersectionality Roundtables (Apr - Sep 14, Brussels) Attended
Intersectionality Conference (Jul 14, Bologna)	Intersectionality Conference (Jul 14, Bologna) Not Involved	Intersectionality Conference (Jul 14, Bologna) Applied (not accepted)	Intersectionality Conference (Jul 14, Bologna) Attended
Organisational Development Capacity Building Seminar (Apr 15, Brussels)	Organisational Development Capacity Building Seminar (Apr 15, Brussels) Not Involved	Organisational Development Capacity Building Seminar (Apr 15, Brussels) Applied (not accepted)	Organisational Development Capacity Building Seminar (Apr 15, Brussels) Attended
Norm Criticism Conference (May 15, Stockholm)	Norm Criticism Conference (May 15, Stockholm) Not Involved	Norm Criticism Conference (May 15, Stockholm) Applied (not accepted)	Norm Criticism Conference (May 15, Stockholm) Attended
Intersex Capacity Building Seminar (Jul 15, Berlin)	Intersex Capacity Building Seminar (Jul 15, Berlin) Not Involved	Intersex Capacity Building Seminar (Jul 15, Berlin) Applied (not accepted)	Intersex Capacity Building Seminar (Jul 15, Berlin) Attended
Homelessness Study Session (Sep 15, Budapest)	Homelessness Study Session (Sep 15, Budapest) Not Involved	Homelessness Study Session (Sep 15, Budapest) Applied (not accepted)	Homelessness Study Session (Sep 15, Budapest) Attended