Horn Bon Virak (Cambodia, 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	HORN BONVIRAK
2. Date of Birth (DD/MM/YYYY)	02 April 1979
3. Country	Cambodia
4. (Organisation affiliated to) optional	CPN+
5. Current occupation	Pos MSM Project Coordinator
6. Number of years working on MSM or TG activities	7 years
7. Phone and Email address	Phone:(+855)-89-313 973
	msmpc@cplplus.org hornvirak@gmail.com
8. Highest educational level attained	High School Diploma
9. Current English language proficiency	Reading Basic Intermediate Advanced Writing Basic Intermediate Advanced Comprehension Basic 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 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?

Yes 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

Skills

-Communication, Research, Managements, Leadership, Report writing, Proposal writing,

Fund Raising, T V Producer, Strategic planning, work Plan, Designing Behavior Chang intervention

Education Skill related to HIV /AIDS, Computer MS. Word & Excel, Meeting and FGD facilitation skill,.

Experiences

-Peer outreach for Safe Project with CARE-Cambodia at Poi Pet

-Commune assistant for Safe Project with CAR-Cambodia at Poi Pet

-Training of Trainer for MSM with CARE-Cambodia at Poi Pet

-Entertainment activities

-Counseling for Safe Project with CARE-Cambodia at Poi Pet

-Program Officer in MSM National Net Work

-MSM+ Project Coordinator based with CPN+

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

- As I think the Leadership Development Program will benefit me by learning more and sharing experiences from the facilitators and others participants from various countries.

_As I think my Leadership capacity is limited which require to be improved

-As I think the program is providing an opportunity for young MSM positive around the world gather to share their personal experiences in the fight against the stigma and discrimination toward MSM.

-As I think the program will also benefit me to learn more about the rights of MSM

-As I think I am HIV+ MSM who is still young to gain more experiences from other MSM from other different countries around the world.

-for the first time in Cambodia I m Represent of MSM to attended meeting in Bangkok in 2004

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

I will bring all the lessons and skills I gained from the program to share with my colleagues as well as other MSM HIV positive in my country by doing the peer-education and outreach in order to help them better understand about the rights as MSM and their responsibilities in contributing to reduce the HIV transmission in the society.