| APPLICATION FORM
Please complete the attached and send together with a photocopy of your passport information page and your submission on your vision for your country/region in 2050 to sidsyouth@gmail.com no later than May 10th 2013. This may be in any format (essay, video, song, poem, painting, etc).
Surname:
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Date of Birth:
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Name:
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Address:
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Nationality:
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Passport No.:
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Email Contact:
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(Please attach photocopy or include scan of passport)
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Phone Contact:
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Please list youth organisations / projects / networks in which you are involved:
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Name and Address of Group:
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Nature of Involvement:
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Have you participated in any of the following:
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Rio+20
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MyWorld Campaign
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BPOA+10 (2005)
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World Youth Congress
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Please nominate referees as follows:
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1. Youth Networks
Name:
Email:
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2. Professional/Academic
Name:
Email:
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3. Personal
Name:
Email:
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Do you have any special needs in terms of travel and logistics? Do you consider yourself part of a minority or vulnerable group? Please give details:
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How well do you speak, write and read English? (1=excellent; 2=good; 3=fair; 4=limited)
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Spoken:
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Written:
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Reading:
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Overall:
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What other languages do you speak?
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1.
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2.
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3.
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4.
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Please rank the following in terms of development challenges for young people in SIDS (1-12):
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Employment
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Health
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Human Rights
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Education
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Climate Change
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Oceans
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Forests
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Waste management
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Preserving culture
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Violence
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Corruption
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Food security
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How could you contribute to the youth meeting (e.g. run a workshop; set up a social networking site in my country; present outcomes from global/regional SD/youth activities; organise a field trip)? Please provide detail:
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Declaration: I hereby declare that I am available to attend the Conference on the dates proposed and agree to abide by the instructions of UNESCO/UNICEF/UNFPA at all times during the Conference. I confirm that I possess a current passport with at least 6 months validity and that I speak English to an adequate standard.
…………………………………………………. (applicant signature)
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For applicants who will be under 18 years of age of 1 June 2013, please complete the following:
Name of Guardian:
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Guardian email:
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Name of Chaperone:
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Nationality of Chaperone:
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Chaperone email:
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Passport No. of Chaperone:
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Date of Birth of Chaperone:
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(Please attach photocopy or include scan of passport)
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Declaration of Guardian:
I hereby consent to _____________________(insert youth name) participating in the SIDS Youth Networking activities in Nadi / Kingston / Seychelles (cross as applicable) under the supervision of ________________________(insert chaperone name)
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Signature of Guardian:
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Signature of Chaperone:
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List of SIDS:
List of Small Island Developing States
(UN Members)
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1
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Antigua and Barbuda
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11
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Fiji
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20
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Fed States Micronesia
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30
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St. Vincent & Grenadines
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2
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Bahamas
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12
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Grenada
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21
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Mauritius
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31
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Seychelles
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3
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Bahrain*
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13
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Guinea-Bissau
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22
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Nauru
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32
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Solomon Islands
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4
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Barbados
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14
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Guyana
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23
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Palau
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33
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Suriname
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5
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Belize
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15
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Haiti
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24
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Papua New Guinea
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34
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Timor-Lesté
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6
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Cape Verde
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16
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Jamaica
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25
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Samoa
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35
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Tonga
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7
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Comoros
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17
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Kiribati
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26
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São Tomé and Principe
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36
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Trinidad and Tobago
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8
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Cuba
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18
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Maldives
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27
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Singapore *
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37
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Tuvalu
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9
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Dominica
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19
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Marshall Islands
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28
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St. Kitts and Nevis
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38
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Vanuatu
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10
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Dominican Republic
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29
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St. Lucia
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List of Small Island Developing States
(Non-UN Members/Associate Members of the Regional Commissions)
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1
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American Samoa
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5
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Comm North Marianas
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8
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Guam
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12
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Niue
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2
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Anguilla
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6
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Cook Islands
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9
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Montserrat
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13
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Puerto Rico
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3
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Aruba
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7
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French Polynesia
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10
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Netherlands Antilles
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14
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U.S. Virgin Islands
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4
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British Virgin Islands
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11
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New Caledonia
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Other Small Island Developing States
(Non-Associate Members of the Regional Commissions/Ass Members of UNDP or regional organisations)
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1
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Bermuda
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3
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Cayman Islands
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2
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Pitcairn Island
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4
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Réunion
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5
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Tokelau
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6
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Turks & Caicos Islands
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7
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Wallis & Futuna
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8
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Leeward Islands
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* Not eligible for funding support
Background documents for further reading:
Barbados Programme of Action 1994 http://www.un.org/documents/ga/conf167/aconf167-9.htm
Mauritius Implementation Strategy http://www.un.org/special-rep/ohrlls/sid/MIM/A-conf.207-crp.7-Mauritius%20Strategy%20paper.pdf
The Future We Want https://rio20.un.org/sites/rio20.un.org/files/a-conf.216l-1_english.pdf.pdf
The Global Conversation begins http://www.undp.org/content/dam/undp/library/MDG/english/global-conversation-begins-web.pdf
www.myworld2015.org
Youth Visioning for Island Living youthvisioning.org/
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