Application form for documentary filmmaking and multimedia training1.General InformationPlease complete the required information in the gaps below Name in Khmer Name in Latin *Gender *Age *Current job Personal phone number *Parent’s phone number Email *Province *Banteay Mean CheyMondulkiriRattanakiriOtherCurrent addressHouse number Street Group Village Commune District Capital/Province 2.Educational LevelPlease choose any degree you have *BachelorAssociate degreeBaccalaureate/ BAC IISkills certificate, if any, please precise 3.Language and ComputerEnglish Language Reading: GoodReading: LittleCannot readWriting: GoodWriting: LittleCannot writeSpeaking: GoodSpeaking: LittleCannot speakOther languages: if any, please precise Computer Can useCannot useInternet Can use internetCannot use internetEmail Can use emailCannot use email4.Experiences and ExpressionA. From what you have experienced or seen in your own community, please describe some issues of women/girls have faced in your community. B. What are the main problems which, women /girls have faced in your community? C. Is there any discrimination against the women/ girls, who have faced the above mentioned issues, in your community? D. How would you contribute to empower the women and girl who are at risk/vulnerable? E. Why do you want to attend in filmmaking training course? F. If you participate in this training course, how would you use your knowledge to address the problems/issues faced by women/girls in your community? THANK YOU Optional (input two digits)This box is for spam protection - please leave it blank:
