Form

Country of Origin*

Current Location (*if different from origin)

First name*

Last name*

Age*

Secure email address*

*A secure email address is an address you are OK to be contacted through to further discuss your application. If you feel that contact with WPHF may put you at risk we suggest that at minimum you use a secure computer, safe internet connection and open a separate, new email account and provide this address in the application instead. We encourage you to use Protonmail.

Country Code*

Phone number/WhatsApp*

Other preferable method of contact

1. Please specify the start date, the duration, the location of the event/meeting and who the organizers are.

Date of the event*

Month/Day/Year

Number of days*

Location of the event*

Organizers of event/meeting*

Website or invitation

Please attach either a program or agenda of the advocacy event/meeting(s)*

2. What type of direct/logistical support are you seeking?
Select all that apply*

Flight

Local Land Travel (bus,car,train)

Visa Fees

Daily Subsistence Allowance (daily meals, incidentals, accomodations)

Access for people living with disabilities

Simultaneous interpretation

Translation of documents

Translation/interpretation needs for people living with disabilities (please specify below)

Other (please specify below)

If you selected 'flight' above. Please indicate the flight details below. Please make sure you have a valid passport ( more than 6 months from the validity end date)

Flight From

Month/Day/Year

Flight Return

Month/Day/Year

If you selected 'other' please specify

Please specify details of translation/interpretation (e.g. language of translation, sign language, etc.)

3. Please let us know if you have submitted a similar application to another organization, and/or received support (financial/non-financial) from another donor. Please note this question is for information purposes and for coordination only and is not evaluated.*

Yes

If yes, what will be covered, and what are the remaining gaps

4. Please tell us about yourself and your experience as a woman human rights defender. How have you been peacefully leading human rights activities in your community/country?
(Maximum 200 words)*

5. What are the objectives of the event/meeting/decision-making process?
(Maximum 200 words)*

6. Please describe your role in the event/meeting/decision-making process, and what you are seeking to influence and achieve.
(Maximum 200 words)*

7. What are the risks you (and/or your dependents) could face as a result of your participation in the event/ meeting/decision-making process? How will you mitigate these risks?
Please list a minimum of two risks and mitigation measures

Risk1*

Mitigation 1*

Risk 2*

Mitigation 2*

Risk 3

Mitigation 3

7. What are the risks you (and/or your dependents) could face as a result of your participation in the event/ meeting/decision-making process? How will you mitigate these risks? Please list a minimum of two risks and mitigation measures

7. What are the risks you (and/or your dependents) could face as a result of your participation in the event/ meeting/decision-making process? How will you mitigate these risks?
Please list a minimum of two risks and mitigation measures