UNESCO World Conference on Education for Sustainable Development Stakeholder Meeting

UNESCO ESD YOU ! CON"E#ENCE

$pplication "orm $%%&'C$ 'ON DE$D&'NE( ) *une +,)Please complete in English. The information you provide in this form will be used solely for the purpose of this conference.

). %E#SON$& 'N"O#M$ 'ON &ast name "irst name Name sho/n on passport Nationalit0 Date of birth (DD/MM/YYYY %lace of birth Se1 Current postal address %hone number (including country code Email addresses (Must be valid through "ovember #$%& Current occupation 'f student2 please specif0 the name of 0our school and 0our ma3or Organi4ation /here 0ou practice ESD %osition or role in this organi4ation Website of the organi4ation English language proficienc0 ( "ative ( "on(native ( English with e)perience living/studying in ( ( Male !emale

(Main Email ('lternative Email

spea*ing countries ( with demonstrated English proficiency Please specify relevant bac*ground+ 1

Can 0ou attend the full program in *apan from 56)7 November +,)-8

Can 0ou participate and contribute to the prior online consultations in September6 October +,)-8 +. #$9E& 'N"O#M$ 'ON (,f you currently hold a valid passport. please provide information below. %assport number Countr0 /hich issued 0our passport Date of issue (DD/MM/YY E1pir0 date (DD/MM/YY Nearest airport 7. :UES 'ONS :)( %lease describe 0our engagement in ESD2 highlighting successful and inspiring initiatives 0ou have been involved in. (0$$ words

( Yes ( "o ,f you answered "- to the above. please specify the dates you can stay in /apan+ ( Yes ( "o

2 3opy the 456 from a YouTube or 7imeo video and paste it 9ideo ;optional< here. You may submit a video presentation illustrating your E1D activity (up to 0 minutes :+( Wh0 do 0ou /ish to take part in this ESD Youth Conference8 !o/ /ould 0ou contribute to its success8 (%8$ words

:7( %lease share 0our ideas as to ho/ ESD can support 0outh in their role as change agents8 (%8$ words

:-( 'n /hat /a0s do 0ou think 0outh can be a driving force for action in education and learning in order to accelerate progress to/ards sustainable development8 (%8$ words

:=( !o/ /ould 0ou disseminate the outcomes of the conference to other 0oung people8 Which relevant net/orks can 0ou make use of8 (8$ words

:5( %lease specif0 the kind of commitment 0ou are read0 to make in order to advance ESD after +,)-. (%8$ words