Nguyen Chung Tai (Vietnam, ppt 1)

Use this form to complete Positive MSM Community Leadership application – please type or print neatly. This form should be completed in English.

The form MUST be signed and scanned and sent as an email to "Nid" thanid@apnplus.org before CBO (5:00 PM Thailand) on 31^st December 2010.

1 - Personal Information

1. Full name of Applicant	Nguyen Chung Tai
2. Date of Birth (DD/MM/YYYY)	11/04/1987
3. Country	Viet Nam
4. (Organisation affiliated to) optional
5. Current occupation	Current occupation
6. Number of years working on MSM or TG activities	03 years
7. Phone and Email address	Phone: (+84) 947110642
	Email: meinekuhl@gmail.com
8. Highest educational level attained	High school
9. Current English language proficiency	Reading Basic X Intermediate Advanced Writing Basic X Intermediate Advanced Comprehension Basic X Intermediate Advanced

Please check the following boxes below as it pertains to you.

a) Do you have a valid passport or willing to acquire a passport at your own expense?

*Yes X No

*Please include a copy of the page that has your information and photo on it i.e. expiry date and passport number.

b) Do you need a visa to travel to Bangkok, Thailand where most of the trainings will be held?

YesX No

2 – Personal Skills and Experiences

Please use this space to detail your skills and experiences in general MSM and HIV intervention activities. For example coordination, peer outreach, edutainment activities and counselling etc.

Maximum of-700 words. DO NOT exceed the space provided

- Advocacy
- Negotiation-presentation.
- Project Management.
- Planning and monitoring and evaluation.
- find information and use information via the internet.

3 – Personal Statement

Please use this space to detail why you think you are suitable for the programme. Maximum of 700 words. DO NOT exceed the space provided

- Participate in activities in the field of HIV / AIDS since 2006 - 2007

- Knowing the MSM, and MSM to work from 2006 to date

- Has attended training on administration and organization of events VSO Vietnam, as well as training courses on capacity building project-management-planning and monitoring-evaluation of advocacy UNAIDS, CARE Vietnam.

4 – Future plan after finishing programme

Please use this space to detail how you would apply the learning and skills gained from the program if you were a successful candidate. Maximum of 700 words. DO NOT exceed the space provided

Have the ability to contribute fully to their own policy reforms in Vietnam on equal rights, regardless of the treatment puzzle-discrimination against people living with HIV / AIDS and MSM. (I myself just as people with HIV, is both the MSM, so I wanted to do something for your community.)

5 – References

Please list two reference persons (i.e. your past or current employer or focal person of PLHIV national network) we may contact regarding the application.

Name	Nguyễn Mỹ Linh
Position	Employees
Organisation	UNAIDS VIET NAM
Phone (including dialling code)	(+84) 912250141
Email	NguyenL@unaids.org
How did you know this person	Job

Name	Phạm Thị Thanh Huyền
Position	Project Management
Organisation	Care Viet Nam
Phone (including dialling code)	(+84) 904117798
Email	ptthuyen@care.org.vn
How did you know this person	Job

6 - Signature of applicant

	Please note that the intention of the APN+ MSM Community Leadership Program is to target those young MSM who are HIV positive within the APN+ affiliated country national networks from the GMR (this includes the whole of China, it is NOT limited to Guangxi and Yunnan provinces only). I hereby certify that the information provided in this application is true and correct. I understand that providing false or misleading information will disqualify me from appointment, or if appointed, will render me liable to dismissal from the program.
	Sign		Date
	Nguyễn Chung Tài		22/12/2010