Application form for Regional E-course on adolescents & youth sexual & reproductive health and rights 3.0

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Deadline: November 30, 2020

More details can be found on http://ypeerap.org/ecourse3
OR
www.facebook.com/YPEER.asiapacific

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Regional E-course on adolescents & youth sexual & reproductive health and rights

1. First Name *

2. Last Name *

3.1 Age *

3.2. Year of Birth (AD) *

4. Gender *

4.1 If not listed, Specify if you would like to:

5. Country *

If not listed, please specify:

6. Email Address *

7. Provide links to your Social Media pages (eg. Facebook , Twitter, Instagram )

8. Your experience as a youth advocate *

I am a member of a youth network / organization / group working in sexual and reproductive health.

I am an independent youth advocate for sexual and reproductive health.

I am a member of a youth network / organization / group working in areas that are NOT sexual and reproductive health.

I am an independent youth advocate for areas that are NOT sexual and reproductive health.

None of the above.

Pflichtfrage

8.1 Name of the network / organization / group/ not involved in any

8.2 What is the area of your expertise? (eg. Comprehensive sexuality education, disability justice, humanitarian, etc...)

8.3. How long have you been working in the area of your expertise which you mentioned in the question above? *

Less than 1 year

1-3 years

3-5 years

More than 5 years

9. Other Affiliation (Education, Employment, etc.) and your position

10. What motivates you to join this course? Write in less than 100 words. *

11. Sexual and reproductive health in your country.

a. Name one sexual and reproductive health issue in your country and briefly explain how it is impacting lives of young people.

b. Name one sexual and reproductive health issue and briefly explain how it is affected by COVID-19.

c. Name one group of young people (eg. people with disabilities) who are most vulnerable to sexual and reproductive health issues in your country and briefly explain why.

Choose only ONE of the questions above, and write a paragraph in less than 100 words. *

12. Where did you learn about this course? (Please be specific) *

13. What skills would you like to strengthen most as a youth advocate? (Select maximum 2) *

Peer education

Meaningful youth engagement and youth-led accountability

Resource mobilization

Using data and evidence based practices for advocacy

Sonstiges:

Pflichtfrage

14.2 Please share if you have any questions / concerns or special requests to the course organizer.

15. Do you identify yourself with any of the following identities / status? Select all that apply.

I am lesbian / gay/ bisexual / transgender/ intersex

I am from an indigenous community

I have a disability

I am a refugee / migrant

None of the above

Prefer not to answer

I have other special identities/status

Sonstiges:

16. Consent *

I understand that the the information I provided will be used solely for this e-course & wont be share with others.

I agree all the information is correct and I will provide additional information if requested

Pflichtfrage

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