Name:........................................................................……………...............

First Name::............................................…………......................................

O Male O Female

Address..….................................................................................................

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Nationality: ..….…............................................................….........................

Date of birth:.……........................................................….............................

Tel : (private) ............................................(prof.)...........................................

Fax : (private)........................................….(prof.)..............…..........…............

E-mail address …….......................................…………………………………….

Present occupation:....................................……...........................................

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Name and address of school/organisation in which you work:

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O primary O secondary O vocational O other

Age of your students:...............................………............................……….....

Subjects taught: ........................……..............………....................................

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Qualifications/Diplomas College/University Subjects Years

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Languages: English O understand O speak O read O write

French O understand O speak O read O write

Other:..........................O understand O speak O read O write

If you have already taken courses on human rights or peace teaching, please indicate:
Organizing Institution Year

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Have you worked in public or private organizations addressing human rights or peace ? (please give a brief description)

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The personal information requested is intended for office use only (for decisions concerning your application).

Please fill in the attached Experience Sharing Questionnaire on the issues of justice

* Applications and Experience Sharing Questionnaire to be returned to the CIFEDHOP, 5, rue du Simplon, 1207 Geneva, Switzerland

• - Where did this experience take place : country, city, school...
• - Describe the cultural, social and economic context in which you carried out your intervention.
• - Who was the target audience?
• - What were the elements that related to the battle against violence?
• - What was the duration of the intervention?
• - What were your specific objectives (knowledge acquisition, skill development...)?
• - What was the subject of the intervention? Give details of the content.
• - What materials did you use?
• - What steps did you follow to achieve your objectives?
• - What pedagogical approach did you use in this intervention
  (presentations, group work, individual work...)?
• - What were the results? How did you evaluate/measure the results?
  Did you achieve all your objectives?
• - Have you repeated the experience?
  Has your approach remained the same? If not, what changed?