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NATIONAL CENTRE FOR ADVOCACY STUDIES

ADVOCACY INTERNSHIP PROGRAMME

APPLICATION FORM (for batch 2010-2012)

To, Executive Director The National Centre for Advocacy Studies Serenity Complex, Ramnagar Colony, Pashan, Pune 411 021

Sir,

I have read the prospectus for the NCAS Advocacy Internship Programme and wish to apply for the same. I am furnishing details about myself as below:

1. Name:

2. Date of Birth:

3. Sex:

4.

Caste:

SC /

ST /

NT /

OBC /

Open

5. Address of Correspondence:

6. Permanent Address:

7. Contact Tel. No./Mobile No

8. E-mail Address:

Affix

your

Photo here

9. Educational Qualifications (Degree / Subject /University / Grade /Year of Passing):

10. What made you apply for this programme?

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11. Why should you be selected?

12. Work Experience (if any):

Have you worked for any social action / human rights / consumer group? If so, describe briefly the nature of your involvement and the work you have done.

13. Present / Current Occupation:

14. From where did you first get information about this Advocacy Internship Programme?

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15. Based on your experience, how do you plan to contribute to social change?

Please write an essay in 500 words on this topic in Hindi or English and send it as an enclosure with this application by e-mail or post.

16. References: Please give two references of persons who know you and whom we may refer to for information about you

Reference 1:

Reference 2:

Name:

Name:

Address:

Address:

Contact tel no:

Contact tel no:

e-mail address:

e-mail address:

Signature:

Date:

Place:

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