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: ________________
Affix
4. Caste: SC / ST / NT / OBC / Open your
Photo here
5. Address of Correspondence:

__________________________________________________________________

__________________________________________________________________

6. Permanent Address:

__________________________________________________________________

__________________________________________________________________

7. Contact Tel. No./Mobile No._______________________________________

8. E-mail Address:_________________________________________________

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: ___________________________