Application Form

Organizational Details

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* 1. Region

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* 2. Name of Applying Organization

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* 3. Organizational Contact Details

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* 4. Type of organization (you may select more than one)

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* 5. Is HIV and AIDS a primary focus of your organization?

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* 6. Organization scope of work (choose a maximum of 5)

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* 7. Which of the following groups does your organization primarily work with? (choose a maximum of 5)

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* 8. Year of establishment

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* 9. Number of employees

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* 10. Number of volunteers

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* 11. Does your organization have a policy of meaningful involvement of people living with HIV and representatives of other communities most affected by HIV? Please describe. (max 200 words)

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* 12. Describe how your organization is involved in HIV and AIDS advocacy at the local, national, regional, and global levels. (max 200 words)

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* 13. Does your organization have experience working with UNAIDS and/or its Co-Sponsors? Please describe. (max 200 words)

Personal Details of Organization's Representative

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* 14. Name

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* 15. Position within the nominating organization

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* 16. Personal contact details

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* 17. Date of birth (DD/MM/YYYY)

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* 18. Gender

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* 19. Nationality

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* 20. Country of residence

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* 21. Working languages

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* 22. Work history (up to 5 organizations employed recently; please include the organization name, years covered and position within the organization)

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* 23. Educational level

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* 24. HIV status

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* 25. Do you personally identify as one of the following groups? (You may check more than one)

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* 26. Which of the following groups do you primarily work with? (Choose a maximum of 5)

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* 27. Identify your skills and fields of personal expertise: (choose a maximum of 3)

Attachments to the application form

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* 28. Statement of the nominating organization

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 29. Personal statement of the nominated candidate

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 30. One-page letter of reference from a relevant national organization in your country, signed by the head of the organization or an authorized representative

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 31. One-page letter of reference from a relevant regional network in your region, signed by the head of the organization or an authorized representative.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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100% of survey complete.

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