ࡱ>  #bjbj! ! CfCf9 8JTT)K\jjjJJJJJJJ$MiPtJjHH"jjJ\J>>>jX\J>jJ>>nADTf/!B JJ0)KBPtP@DD@PFjj>jjjjjJJtjjj)KjjjjPjjjjjjjjj :  ACCREDITATION APPLICATION FOR THE PARTICIPATION OF CIVIL SOCIETY IN THE REGIONAL MEETING FOR THE INTERNATIONAL DECADE FOR PEOPLE OF AFRICAN DESCENT (Brasilia, Brazil, 3 4 December 2015) PART I. TO BE SIGNED BY THE HEAD OF THE ORGANIZATION General information: Name of NGO: Address: Country: Phone number: Fax: Contact e-mail address: Website of NGO: Name of Head of organization: Year of establishment of the organization: Information on the selected NGO representative [it is mandatory to complete application with copy of the representatives national passport which will be used for travel purposes]: Name of representative: Date of birth: Gender: Female ( Male ( Email address: Phone number (office and mobile number if available): Information on the NGO: Status: Does the NGO have ECOSOC consultative status? Yes ( No Was your NGO accredited to the 2001 World Conference against Racism, Racial Discrimination, Xenophobia and other Related Intolerance? Yes ( No ( Was your NGO accredited to the Durban Review Conference? Yes ( No ( Does your organization represent people of African descent: Yes ( No ( 3. If yes, is your organization working on: Women rights ( Youth issues ( Research ( Administration of justice ( Issues related to empowerment ( Economic, social and cultural rights ( Other, specify ______________________________________________________________________________________________________________________________________________________________________ 4. Please provide information on activities your NGO has carried out since the World Conference Against Racism (WCAR): Kindly provide a brief list of your World Conference follow-up related activities: ____________________________________________________________________________________________________________________________________________________________________ On what recommendation(s) from the Durban Programme of Action has your organization specifically followed-up? ____________________________________________________________________________________________________________________________________________________________________ Has your organization been engaged with the WCAR follow-up mechanisms and if so, how? ____________________________________________________________________________________________________________________________________________________________________ d. On what recommendation(s) from the Programme of Activities for the International Decade for People of African descent is your organization specifically following-up? ____________________________________________________________________________________________________________________________________________________________________ 5. Does your organization operate at the national and/or grass-root level: __________________________________________________________________________________ I certify that the information provided in answer to the foregoing questions is true, complete and correct. Enclosed is a photocopy of the passport of the NGO representative proposed to attend the meeting. I certify that he/she is a member of the organization. 6. Please indicate if your organization would like to applying for funding? Please note that OHCHR will provide assistance to a limited number of selected civil society representatives, based on the criteria established in Information Note N 2 of 26 October 2015. Yes ( No ( 7. Please indicate if you have any support requirements on the basis of disability _________________________________________________________________________________________ Date: ________________ Signature of the Head of the Organization ___________________________ PART 2. TO BE SIGNED BY THE PROPOSED NGO REPRESENTATIVE The undersigned, representing the NGO, hereby undertakes to respect and adhere to the United Nations principles, as well as established rules and procedures while participating in meetings and activities in United Nations premises in the context of the International Decade for People of African descent. The undersigned also commits to undertake activities in full conformity with the letter and spirit of the Durban Declaration and Programme of Action, and with the principles outlined in ECOSOC resolution 1996/31 on the consultative relationship between the United Nations and non-governmental organizations. 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