Annex 2 – Application Form
APPLICATION FORM
※
Please review the concept note prior to your application
FAMILY NAME
FIRST NAME
MIDDLE NAME
(if any)
GENDER
DATE OF BIRTH
(day/month/year)
PLACE AND COUNTRY OF
BIRTH
NATIONALITY (as
on your passport)
TELEPHONE NO
ADDRESS
AFFILIATION
Enrolled student of:
Na
me of school
Field of Study:
Name of enrolled course
Enrolled for:
Nam
e of
degree
LOCATION
OF
UNIVERSITY
(CITY/COUNTRY)
LEARNING
LANGUAGE
MOTHER
LANGUAGE
OTHER
LANGUAGE
Indicate by elementary, intermediate, advanced and fluent
READ
WRITE
SPEAK
UNDERSTAND
sample, English
LANGUAGE PROFICIENCY TESTS : State valid scores of English language proficiency tests (if
any, such as TOEFL, TOEIC, TESOL, FLEX)
NAME OF TEST
SCORE
DATE OF TEST
HIGHER EDUCATION
SCHOOL/INSTITUTION
PLACE AND COUNTRY
TYPE
ATTENDED FROM/TO
CERTIFICATES
OR DIPLOMAS
OBTAINED
MONTH/
YEAR
MONTH/
YEAR
1
Advanced
Advanced
Intermediate
Advanced
-
-
-
-
-
-
-
-
OTHER ACTIVITIES
Write in REVERSE ORDER, starting with your present activities, such as intern experience,
volunteer work, publications etc
TYPE
TITLE, INSTUTITON
DESCRIPTION OF
TASK/DUTY/ACTIVITY
DURATION
I certify that the statements to the above questions are true and correct to the best of my
knowledge and belief. I understand and accept that any false statements, or willful
misrepresentation or material omission made on the Application Form or other documents
requested by WHIPIC can render the candidate’s registration to the event null and void.
DATE : day/month/year
SIGNATURE:
A
2
Motivation Statement
※
Each team member should write their individual motivation statement
1
Please state your motivation for participating in the Workshop, and what
you hope to learn from it (maximum 300 words)
Write here
2 Propose your thoughts on what heritage interpretation is. Explain why
you think heritage interpretation is necessary (maximum 300 words)
Write here
3
Consent to the Collection and Use of Personal
Information
The International Centre for the Interpretation and Presentation of World Heritage
Sites (WHIPIC) will collect and use personal information as follows to pay the
honorarium related to the 2023 Youth Capacity Building Training for World Heritage
Interpretation and Presentation event. Please read the content carefully and decide
whether to agree or not.
Collection and use of personal information
Items to be
Collected/Used (Required)
Name, Address, Phone Number, Affiliation, E-mail
Address, Nationality, Language skill and test
scores, Employment and other activity records
Purpose of collection and
use
Selection of Participants and for the orgnanisation
for the 2023 Youth Capacity Building Training for
World Heritage Interpretation and Presentation
Duration of retention and
use
5 years (Under PUBLIC RECORDS MANAGEMENT
ACT, during the records retention period)
You have the right to refuse to consent to the collection and use of your personal
information above. However, if you refuse to consent, your application will not be
considered. Do you agree to the collection and use of the above personal information?
Name: Write here
Date: day/month/year
Agree ☐ Do Not Agree ☐
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