APPLICATION FORM

CERTIFICATE PROGRAM IN COMMUNITY DEVELOPMENT AND

CIVIC EMPOWERMENT (CDCE)
Faculty of Social Sciences
Chiang Mai University, Thailand

January – March 2009

Please read the following information carefully before completing the application form.

Introduction

The CDCE program is a three-month intensive program designed to provide basic knowledge and skills
for younger generations of community development workers, NGO managers and grassroots change-
makers in the least developed countries of Southeast Asia. The trainees will learn the conceptual
foundations of community development skills that are applicable in complex institutional environments.
The training program will provide participatory and interactive classroom-based learning combined with
field trips and observation tours to study the real-world activities and best practices of development
NGOs and other civic groups.

In-Class Lectures and Discussions

In-class lectures and discussions will have three core components. The first component, “Core and
Foundation,” deals with global issues and local trends of development while the second component
introduces the basics of “Development Management.” The third components focuses on “Specialized
Skills” that are applicable to the institutional contexts of Southeast Asia. In-class lectures and
discussions are designed to encourage active participation from the trainees.

Field Trips and Observation Tours

After a number of weeks of in-class training, the participants will travel to various areas of Northern
Thailand to see and learn how development NGOs work in various streams of community development
activities. During this time, guest speakers comprising of seasoned practitioners and experts in
community development and other related areas will be invited to share their real-life experiences and
understanding of development challenges and issues.

Team Project and Active Learning

Participants will be required to carry out various group activities and a team project during the training
period. Participation and successful completion of the team project is a requirement for the certificate of
completion for the three-month program. Participants are strongly encouraged to bring research papers,
documentations and other information that can be relevant in developing projects of their own choice.

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Participants will receive hands-on learning about specific issues concerning development work through
active participation in various assignments of research, documentation, discussions, sharing and writing
the final presentation. CDCE will do its best to provide support and further assistance to the best
projects designed and developed by the participants.

Requirement for CDCE Applicants

Applicants must meet the following qualifications:

1. Participants must hold a university degree from one of the recognized educational institutions in
your country of origin or elsewhere. Other candidates who have also completed university-level
degree program from distance learning institution or open universities may also apply.
Participants who do not hold a university degree as a result of being from a marginal or
vulnerable group whose educational opportunities are limited due to social exclusion will be
considered for the admission on case-by-case basis. The applicants under such category should
write a cover letter explaining the challenges he or she has faced in obtaining an education.
2. Participants must have at least two years of experience in community work or similar experience
working with charity organizations, community-based organizations, local NGOs, international
development organizations, or religious organizations that conduct community work.
3. Participants must have at least basic English language skills (speaking, understanding spoken
English, reading and basic writing).
4. Participants must demonstrate commitment to and flexibility in working with diverse groups.
They must respect all participants regardless of their race, religion, age, gender, sexual
orientation or opinions.
5. Participants must be able to participate in all activities, including group decision making-process,
sharing their knowledge and constructively engaging in group discussions.
6. Participations must be medically capable of joining the program.
7. Participants must strictly adhere to the prevailing laws and regulations of Thailand as well as
other rules set by the program throughout the period of training, and must promptly return to
their country after the program. CDCE reserves the right to dismiss the trainee if he/she violates
the rules.
8. Participants should begin the process of acquiring necessary travel formalities or passports by the
time of application. Participants are also required to submit the passport details in photocopy to
apply entry visa for Thailand.

All individuals who meet the above criteria are encouraged to apply. We strongly encourage
applications from women, representatives of minority groups and other community development workers
who aspire to develop their own initiatives or programs benefiting their communities.

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Application Process:

1. Application Form: Participants should fill out the application form and answer the essay questions.
Answers can be hand-written or typed. If more space is needed, answers can be written on a
separate sheet of paper. Applications can be sent by post or e-mail.

2. Recommendation Letter: Participants are required to submit two recommendation letters from
people who know them well. Ideally, one recommendation should be from a member of an
organization the participant is involved with and the other should be from a community member
(teacher, religious or community leader, etc.) The person should complete the attached
recommendation form. Then the applicant can include it with their application or the person who
wrote the recommendation can send it to CDCE directly.

3. Interview: Applicants may be subject to an in-person or telephone interview, which will be

conducted by a local member of the selection panel or Chiang Mai University representatives.

4. Participant Selection: Based on their application, recommendation letters and interview results,
candidates will be chosen to participate in the CDCE program.

Defiantly
CDCE Tentative Program Calendar*
September – December 2009

Application Deadline and Procedure Calendar

15th June 2009 Application Deadline - applications must be received by this day.
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25 June 2009 Short listed applicants will be notified
1st-10th July 2009 Short listed participants may require interviews
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20 July, 2009 Finalized Participant List Announced
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17 Sept , 2009 Final Preparations for Travel to Chiang Mai University Thailand
19 th Sept 2009 All participants must arrive Chiang Mai, Thailand by this date.

Training Program Calendar

19th Sept 2009 Arrivals of participants
21 Sept 2009 Registration/ Orientation/ Campus Visits/ City Tours
th th
21 Sept – 28 Nov In-class lectures on core foundation courses (2 weeks)
Development Practicum (1 week)
Development Management courses (2 weeks)
Specialized Skills courses (2.5 weeks)
Field Trip (1 week)
3rd -4th Dec, 2009 Team Presentations
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4 Dec , 2009 Graduation Ceremony
5th Dec, 20009 Departure of Participants and End of the CDCE Program

*Dates are subject to change without prior notice.

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CDCE Participant Information

Please give us the following information. If you have any questions, you may send your queries to
natta@chiangmai.ac.th by June 15th , 2009.

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

Date of Birth: …....……… Age:……… Sex: M / F ………..

Nationality: …………………………………

Languages that you can speak: ……………………………………………………………………

Marital Status: Single Married

Contact Information: (Please give at least email or telephone for scheduling interviews)

Address: ……………………………………………………………………………………
……………………………………………………………………………………

Telephone: ………………………………

Fax: …………………......………………..

E-mail: ........………………………………

Education

Highest Education Level Attained:……………………………………………………………..

What schools have you attended?

Name: ……………………………………… Location:………………Dates: ……………....

Name: ……………………………………… Location:………………Dates: ……………....

Name: ……………………………………… Location:………………Dates: ……………....

What trainings or workshops have you attended?

1. Name of Training:………………………………………....…………………………………

Organized by: ……………....………….... Location:………………………Dates: ……………....

2. Name of Training:………………………………………....……………………….…………

Organized by: ……………....………….... Location:………………………Dates: ……………....

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3. Name of Training:………………………………………....……………………… ……………

Organized by: ……………....………….... Location:………………………Dates: ……………....

4. Name of Training:………………………………………....……………………………………

Organized by: ……………....………….... Location:………………………Dates: ……………....

Work Experience/History

Where are you currently working? (Name of Organization) ……………………………………….

………………………………………………………………………………………………………..
Address:

……………………………………………………………………………………………..

……………………………………………………………………………………………………….

Email……………………………………………...

Current Position:……………………………………………………….......……………………...

Responsibilities/Duties: ………………………………………………………...................……….

……….............……….............……….............……….............………...................………………..

How long have you worked here? …….…………………...………………………………………

What other jobs do you or did you have?

Job title: ……………………………………… Organization :………………………………….

Location: ……………………………………… Dates:………………………............……………

Responsibilities/Duties: …………....……………………………………………………………….

……………………………………………………………………………………………………......
Job title: ……………………………………… Organization :………………………………….

Location: ……………………………………… Dates:………………………............…………...

Responsibilities/Duties: …………....………………………………………………………………

……………………………………………………………………………………………………...

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Name of the persons writing your recommendation letters:

1. Name: …………………………………………….. Organisation: ……………………………

Address: ……………………………………………………………………………………………

Email …………………………………………………………………………………………….

Telephone: …………………………………………………………………………………………

2. Name: ……………………………………………..... Organisation: ………………………….

Address: ……………………………………………………………………………………………

Email: …………………………………………………………………………………………….

Telephone: …………………………………………………………………………………………

Applicant’s Knowledge on Community Development

1. Why are you interested in this program? (300 words)

2. What are your expectations from this program? (300 words)

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3. Describe your previous experience in community development activities? (500 words)

4. Describe at least two areas/issues that you find most difficult to solve/ deal with in your community
work. (300 words)

5. Do you have any priority knowledge of any of the subjects to be taught at the program? If any, please
explain. (200 words)

I certify that I wrote these essays by myself.

Signed _____________________________________________ Date ___________

Please send to:

CDCE Program
Faculty of Social Sciences
Chiang Mai University
Chiang Mai 50200, Thailand
Tel: 66-53-226697; Fax: 66-53-226698
Email: natta@chiangmai.ac.th, cdceprogram@gmail.com

Application Deadline is June 15, 2009

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 CDCE Training Program: September – December 2009

RECOMMENDATION FOR ………………………………………………………

(Name of Applicant)

SECTION 1:

Your name: ………………………………………………………

Name of organization: ………………………………………………………
Responsibility within organization: ………………………………………………….......

SECTION 2:

Please answer the following questions:

How long have you known the applicant? ………………………………………………..
……………………………………………………………………………………………..
……………………………………………………………………………………………..

Please explain your relationship to the applicant:…………………………………………. ………………

………………………………………………………………………………
………………………………………………………………………………………………

Please comment on why you support the applicant’s candidature for the CDCE program:
………………………………………………………………………………………………
………………………………………………………………………………………………

Please comment on the applicant using his or her knowledge about Community
Development and Civic Empowerment in the future:
………………………………………………………………………………………………
………………………………………………………………………………………………

SECTION 3:

Please give an assessment of the applicant’s skills and abilities in the following areas.

Please write a number between 1 and 5.

Note: 1 = Poor / 2 = Fair / 3 = Good / 4 = Very Good / 5 = Excellent / ? = Not sure

Applicant’s ability to remain independent (.………)

Applicant’s level of maturity (……….)

Applicant’s ability to grow and develop skills and experience (……….)

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Applicant’s ability to act responsibly and take responsibility for own actions (……….)

Applicant’s level of motivation (……….)

Applicant’s learning potentials (……….)

Applicant’s tolerance of diversity in race, religion, gender, etc. (……….)

Ability of applicant to foster friendly and productive community relations (……….)

Ability of applicant to apply knowledge and skills to real-life situations (……….)

Ability of applicant to communicate openly and reasonably (……….)

Ability of the applicant to working in team settings (……….)

Applicant’s experiences/interest in social & environmental issues (……….)

Applicant’s ability to communicate in the English language (……….)

Applicant’s commitment to community development (……….)

Please use the following space to make any other relevant comments about the applicant:

…………………………………………………………………………………………….

…………………………………………………………………………………………….

…………………………………………………………………………………………….

I, __________________________________, certify that ________________________________________

(Your Name) (Name of applicant)
is a strong and suitable candidate for admission into the CDCE Program.

Signed: ………………………………………………… Date: …………………………

Please return the completed recommendation form to the applicant or send directly to:

CDCE Program
Faculty of Social Sciences
Chiang Mai University
Chiang Mai 50200, Thailand
Tel: 66-53-226697; Fax: 66-53-226698
Email: natta@chiangmai.ac.th

APPLICATION DEADLINE IS JUNE 15, 2009

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 CDCE Training Program: September – December 2009

RECOMMENDATION FOR ………………………………………………………

(Name of Applicant)

SECTION 1:

Your name: ………………………………………………………

Name of organization: ………………………………………………………
Responsibility within organization: ………………………………………………….......

SECTION 2:

Please answer the following questions:

How long have you known the applicant? ………………………………………………..
……………………………………………………………………………………………..
……………………………………………………………………………………………..

Please explain your relationship to the applicant:…………………………………………. ………………

………………………………………………………………………………
………………………………………………………………………………………………

Please comment on why you support the applicant’s candidature for the CDCE program:
………………………………………………………………………………………………
………………………………………………………………………………………………

Please comment on the applicant using his or her knowledge about Community
Development and Civic Empowerment in the future:
………………………………………………………………………………………………
………………………………………………………………………………………………

SECTION 3:

Please give an assessment of the applicant’s skills and abilities in the following areas.

Please write a number between 1 and 5.

Note: 1 = Poor / 2 = Fair / 3 = Good / 4 = Very Good / 5 = Excellent / ? = Not sure

Applicant’s ability to remain independent (.………)

Applicant’s level of maturity (……….)

Applicant’s ability to grow and develop skills and experience (……….)

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Applicant’s ability to act responsibly and take responsibility for own actions (……….)

Applicant’s level of motivation (……….)

Applicant’s learning potentials (……….)

Applicant’s tolerance of diversity in race, religion, gender, etc. (……….)

Ability of applicant to foster friendly and productive community relations (……….)

Ability of applicant to apply knowledge and skills to real-life situations (……….)

Ability of applicant to communicate openly and reasonably (……….)

Ability of the applicant to working in team settings (……….)

Applicant’s experiences/interest in social & environmental issues (……….)

Applicant’s ability to communicate in the English language (……….)

Applicant’s commitment to community development (……….)

Please use the following space to make any other relevant comments about the applicant:

…………………………………………………………………………………………….

…………………………………………………………………………………………….

…………………………………………………………………………………………….

I, __________________________________, certify that ________________________________________

(Your Name) (Name of applicant)
is a strong and suitable candidate for admission into the CDCE Program.

Signed: ………………………………………………… Date: …………………………

Please return the completed recommendation form to the applicant or send directly to:

CDCE Program
Faculty of Social Sciences
Chiang Mai University
Chiang Mai 50200, Thailand
Tel: 66-53-226697; Fax: 66-53-226698
Email: natta@chiangmai.ac.th

APPLICATION DEADLINE IS JUNE 15, 2009

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