Conchita Poncini Jimenez International Human Rights Fellowship Application

Applications and all supporting documents must be sent to [email protected] by 30 June 2012.

IFUW

PERSONAL DATA
1. 2. 3. 4. 5. 6. 7. 8. 9. Title (Professor, Dr, Mrs, Ms, Miss): Family name: Other names: Date of birth (day/month/year): Nationalities: Country of permanent residence: Country where currently residing: How long have you been there? Languages: (Please indicate whether ability to read, speak and write is excellent, fair or minimal.) First Language: Other languages: 10. Permanent address:

11.

Mailing address (if different from above):

12. 13. 14.

Telephone (including country code): Mobile number (including country code): E-mail:
International Federation of University Women Fdration Internationale des Femmes Diplmes des Universits
10, rue du Lac, CH-1207 Geneva, Switzerland; Tel: (+41 22) 731 23 80; Fax: (+41 22) 738 04 40 E-mail: [email protected] Website: http://www.ifuw.org

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International Federation of University Women Fdration Internationale des Femmes Diplmes des Universits
10, rue du Lac, CH-1207 Geneva, Switzerland; Tel: (+41 22) 731 23 80; Fax: (+41 22) 738 04 40 E-mail: [email protected] Website: http://www.ifuw.org

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EDUCATIONAL AND PROFESSIONAL BACKGROUND

16.

Beginning with the most recent, list any other relevant professional qualifications: Granting Body Date Awarded Discipline Nature of Award

a. b. c. d.

17.

Beginning with the most recent, list up to four awards or fellowships you have held: Title of Award/Fellowship University/Institution Dates held Amount of Award (including currency)

a. b. c. d.

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EMPLOYMENT HISTORY
18. Beginning with the most recent, list up to four of your most relevant employment experiences, including title/nature of the position, name and address of employing institution/ organisation, and dates of employment: Title/Nature of Position a. b. c. d. Name and Address of Employer Dates of Employment Brief description of the work

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
21. Beginning with the most recent, list up to 8 of your publications (articles, books, or theses) with full bibliographic

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
Most

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
a.

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
b.

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
c.

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
d.

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
e.

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
f.

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
g.

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19.

Beginning with the most recent, list up to four examples of your membership of and service to relevant Non-Government Organisations, including name and address of the non-governmental organisation, service rendered to or office bearing position within the organisation, dates of membership/service: Name and Address of the Non-Governmental Organisation Position in and/or service to the organisation Dates of membership /service Brief description of the work done/service rendered to the organisation

a.

b.

c.

d.

20.

Position or activity you plan/hope to take up upon completion of your research/study/internship:

PUBLICATIONS
h.

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PROPOSAL OVERVIEW
22. Purpose for which the fellowship will be used Research Study Internship with an international or national human rights organisation 23. 24. Starting date of research/study/internship and expected date of completion: Name and address of the university/institution/human rights organisation where the project is to be carried out, including street address, city and country:

25.

Project Description (not to exceed 800 words) Proposals for research should include: objectives of the investigation or critical interpretation; the hypothesis to be tested (if applicable); a description of the methodology to be used, with reference to relevant literature; an indication of the present status of the work; a list of steps to be undertaken; an estimation of the time required to complete the project; your reasons for selecting the place of study. Proposals for study should include: reasons for undertaking the programme, a list of courses to be taken and the reasons for your place of study, expected diploma or degree. Proposals for an internship should include: reasons for choosing the host organisation, a description of the host organisations work related to womens and girls human rights; and the nature of assignment or project you will complete during your internship.

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FINANCIAL DETAILS
Applicants should provide reliable estimates for fees, accommodation and subsistence during the period for which support is requested. Please indicate all amounts in Swiss francs (CHF); estimates in other currencies will not be considered. Requests for support should not exceed either 12 months full-time or 24 months part-time. The period of support must take place within the period, 1 September 2012 to 31 December 2014. 26 .
Total estimated costs: (in Swiss francs - CHF)

Tuition & Fees

Total Costs:

Amount requested from IFUW:

27 .

Details of the "other" costs listed above, if any:

28 .

Amounts and sources of any other funds which you know you will have available to help pay for the research/study/training for which you are requesting an award. Include salary, personal funds and any other fellowships/scholarships/grants you have already been awarded toward this proposal.

29 .

List any other fellowships/scholarships/grants for which you have applied, but have not yet received a decision (including amount, exact name of award, given by whom). If successful, you must notify IFUW immediately.

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If there is a substantial difference between your estimated costs and the IFUW award offered plus the funds listed above, how do you plan to cover this deficit?

ADDITIONAL DOCUMENTS TO BE SUBMITTED WITH THE APPLICATION For your application to be considered, the following documents must be submitted with your application: 31. A confirmation letter from the host university/institution/organisation. If the letter is not written in English, a translation must also be provided. 32. A personal statement, not to exceed 800 words, explaining your reasons for applying for the fellowship, your past experience related to womens and girls human rights and how this relates to the fellowship, and how you will use the new human rights experience in the future. LETTERS OF REFERENCE 33. In addition, each candidate must ask three referees to send letters of reference direct to IFUW at [email protected] by 30 June 2012. Candidates will be notified when references have been received. It is the candidates responsibility to make any necessary reminders. One should be from a faculty supervisor or work supervisor from a relevant organisation. The other two should be people familiar with your work related to womens and girls human rights. The referees should indicate in their letters how long they have known you and in what capacity, and give some indication of your potential for completing and benefiting from the proposed project. All letters must be on the official letterhead of the respective organizations, signed and sent direct to IFUW by the referee as a pdf or jpg attachment. Each referee must provide an official email address and telephone number where IFUW can acknowledge the reference and ask for further information, if necessary. DATE AND SIGNATURE In typing your full name and date in the space below you are attesting that the information provided in the application is accurate. 34. Signature (full name):

35.

Date: