Country Representatives Applicants Form

Note: fields marked with an asterisk (*) are required.

*First Name:

*Last Name:

*Gender:

Title :

Organization/Company:

*Address 1:

Address 2:

*City:

*Province/State:

*Zip/Postal Code:

*Country:

*Telephone:

Fax:

TTY:

*Email:

Website:

*1. Please Indicate Your Primary Areas of Expertise in Universal Design, Accessibility , Human Rights and/or Technology

(Examples: Access to the Built Environment, Universal Design, Health Care, Education, Transportation Facilities, Architectural Design, Codes and Standards Development, ICT’s. Training, Human Rights, UN Convention, Disaster and Emergency Preparedness, Access to Justice, Education, etc.): (character limit 300 characters)

*2. If you have affiliations with other NGO’s, Organizations of Persons’ with Disabilities (ie: DPI), Professional Associations (ie: Association of Architects), etc., please list those here:

3. Country you would like to represent and why

Country:

Explanation:

*4. List the relevant accessibility related activities you have been involved in during the last year in this country:

*5. Why do you want to be a GAATES Country Representative?:

*6. How do you think you can contribute to GAATES mission and objectives?:

*7. What do you expect from GAATES if accepted as a Country Representative?:

Upload the following :

*Your Resume:

*A Headshot photo of yourself: