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I. Information on the indigenous organization/community

1. Name of the indigenous organization/community submitting an application for its indigenous representative: ...................................................................................................................................................................................
...................................................................................................................................................................................
Mailing address:..............................................................................................................................................................
...................................................................................................................................................................................
...................................................................................................................................................................................
Telephone (with country and city codes):   .........................       Fax:  ...........................     Email: ........................................

2. Description of the activities of the indigenous organization/community:
 
 
 
 

3. Annual budget of the indigenous organization/community (in dollars of the United States):
 
 

4. A letter of nomination and recommendation signed by an executive official or body of the applicant's indigenous organization or community must be attached to this form.  Without this signed letter, applications will not be complete and the Board of Trustees will not be able to consider the application.

5. Indigenous representative proposed for a grant. (If the organization wishes to nominate two applicants, a separate application form should be filled in for each applicant; maximum two applicants per organization/community. The Board encourages indigenous organizations/communities to propose, if possible, one woman and one man):

Family name:   ...................................              First name:   .............................................................................................
Gender: ............................................              Nationality:  ...................................   Date of birth:  ...................................

Responsibility of applicant in the organization/community:  ......................................................................................................


Profession and occupation of applicant: ................................................................................................... ...........................
A curriculum vitae of the applicant should be attached


Indicate the name of the indigenous population which the applicant belongs to:..........................................................................
The representatives must be indigenous persons

Address of Applicant:..........................................................................................................................................................
......................................................................................................................................................................................
Telephone (with country and city codes):  ...................................        Fax: ............................         Email:  ............................

Languages Spoken:..................................................................................................................................

Please note that the official languages of the Working Group  (simultaneous interpretation) are Arabic, Chinese, English, French, Russian and Spanish. The representatives must understand and speak one of these languages.

6. Experience of the applicant in questions relating to indigenous populations:
 
 

7. What will be the substantive contribution that the applicant will make to the discussions of the Working Groups (please indicate which themes will the applicant present to the Working Group):
 

   /_/ WGIP (The main theme of the 23rd session of the Working Group will be "Domestic and international protection of indigenous traditional knowledge"; the applicant should also address the Working Group on this theme):

   /_/ WGDD (which article of the draft declaration will the applicant discuss):

8. Indicate which indigenous population(s) the applicant will represent and provide relevant information on their situation, geographical location and demographic data:
 
 

9. Indicate if the applicant has already participated in the sessions of the WGIP/WGDD/WG on the Permanent Forum/PFII.

Name of meeting........................................................................................Year:...........................................
Attach any statement made at these sessions.

10. Indicate if the applicant has already benefited from a travel grant from the Fund to attend the WGIP/WGDD/WG on the Permanent Forum/PFII.

Name of meeting: ........................................................................................................... Year: .....................

11. Please indicate the reason why you request financial assistance from the Fund:
 

12. Grant requested (please mark the correct box):

    /  / Full. Includes air travel on economy class and daily subsistence allowance. Grants do not include health, accident or travel insurance.

    /  / Partial.  Indicate which part and amount of expenses will be covered by yourself/your organization:

13. Proposed travel itinerary from your home town/city to Geneva (cities of transport, modes of transportation plane/train/bus, dates):
From (town/city).............................................through (city).............................................to Geneva.

14. Please indicate your closest airport of departure. If possible, tickets from regional airports will be issued if not, they will be reimbursed later on. Local transportation by bus or train will be reimbursed later upon presentation of the original bills.
Airport:......................................... Location:.........................................
 
Would you authorize the secretariat of the Fund to allow other organizations, such as UNITAR or the International Service for Human Rights (ISHR), to have access to this application form so that they may contact you to invite you to attend other events? Yes /__/ No /__/

 Signature of the applicant    ...........................................                Date   ...........................................
 

THIS APPLICATION HAS TO BE SIGNED, DATED AND ACCOMPANIED BY A LETTER OF NOMINATION AND SENT BY 1 OCTOBER 2004 TO: Secretariat of the Voluntary Fund for Indigenous Populations, Ms. Eulàlia Ortadó, Office of the United Nations High Commissioner for Human Rights/ CH-1211 Geneva 10 - Switzerland tel. (+41 22) 917 91 64/91 45 - fax (+41 22) 917 90 66 Email: eortado-rosich@ohchr.org/emonsalve@ohchr.org For more information on the Fund or the Working Groups, please consult OHCHR's Website page: http://www.unhchr.ch/html/menu2/9/vfindige.htm

Due to the large number of applications received, only beneficiaries of a grant will be notified.
You are invited to consult the list of beneficiaries which will be available on the Fund's Websited shortly after the decisions are taken (http://www.unhchr.ch/html/menu2/9/vifindige.htm)

_________
1/  The application form must be completed in English, French or Spanish and all questions must be answered. Please use additional pages if needed to properly answer all questions.

2/  In order to be able to attend this Working Group please note that in accordance with Commission on Human Rights resolution 1995/32, organizations must have the ECOSOC consultative status or be authorized by the ECOSOC Committee on Non-Governmental Organizations.

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