29/1/2016 ApplyfortheAgency| PeaceRevolution

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Dear Gaby Yepes,

Please read this carefully before you apply.

If you are on this page, it is because you have come to the conclusion that the Peace Revolution is exactly the kind of activity
in which you want to participate.

We just need a bit more information about yourself including contact information, educational information, work experience
and some additional answers. Please try to provide as much information as possible since the information will be forwarded
to the selection committees as well as the sponsor. Your portrait photo is also needed. If you are using some other picture in
your profile, please re-upload your portrait photo. We also need to contact you for an online interview so please tell us the
accessible phone numbers. Skype interview is more preferred though.

There is one more thing. Make sure that your name Gaby Yepes appears exactly the same as the name in your
passport/travel document. If not, please edit your name below. Note that the right for the fellowship cannot be transferred to
someone else.

Fellowship :

Youth Fellowship in June 2016 Global Peace on the Move 18

Venue :

Mooktawan

Date :

16th - 29th June 2016

Required Self-development Days:

42 days

Required Special Ops:

Application Deadline:

28th February 2016 (in 29 days)

Eligibility Deadline:

11th April 2016 (in 72 days)

What is your motivation of joining this activity? What do you expect from the fellowship?:

Mini PIPO Proposal

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Mini PIPO Proposal

Here you will also be able to submit your Mini PIPO Proposal regarding future plans between you, your community and Peace
Revolution itself. Bear in mind that the deadline to submit the final proposal will be the same one set to fulfil all the rest of the
eligibility requirements, which means that your proposal will be editable until that date.

A Mini PIPO proposal is a space for you to submit your possible commitment towards Peace Revolution. As you may have
read, we call PIPO (/docs/en/the-pipo-on-demand) to the series of meditation events a peace agent (someone that has
attended the International Fellowship in Thailand) organizes in his/her country once he or she has returned home. The event will
be supported by the Peace Revolution crews as well as a teaching monk will travel to facilitate Inner Peace Time sessions. Here
we are interested in knowing what do you think about if, whether you would be able to do that, which kind of contacts you have,
possible venues, estimated amount of people, how you would plan to do that, etc. So, this is a space for you to also add or tell
us about different ideas you have to keep engaged with the organization regardless the possibility of organizing PIPO, for
example linking your organization with ours, helping us in a specific area of your expertise, organizing periodic online meditation
sessions, etc.

Proposal:

Venue:

Expected Number of Participants:

Contact Information

Name:

GAby

Middle name

Yepes

Your name is only available to the Peace Revolution Crew and your Peace Coaches.

Other name:

Other names you are known by or have ever been known by

Gender

Male Female

Date of birth

1975-12-13

Nationality

Nationality

Country of birth:

Peru

Permanent country of residence:

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Permanent country of residence:

Peru

Current residential address:

Present country:

Peru

Home phone:

Mobile phone:

Skype address:

Please enter a Skype address as it is needed for an interview process and Online Special Ops.

Facebook:

https://www.facebook.com/app_scoped_user_id/10153547005952961/

Photo and Travel Document

Portrait Photo (size &le, 1MB)

Click "Select Files" to add photo files into this list. Then click "Upload Files" to upload.
Select Files Upload Files

Please provide a portrait photo of yours. This photo will not replace the display photo you are using. It will only be used by the interviewing process
and will not be displayed publicly on the Peace Revolution website. Click here (//cloud.peacerevolution.net/img/page-apply-for-agency/portrait-
photo-example.jpg) for an example of the photo we want. The photographs must be less than six months old.

Do you have a travel document/passport?:

Yes No

Issuing Country:

Country

Passport Number:

Passport Expiry Date:

Other citizenships you hold:

Do you have another passport?:

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Do you have another passport?:

Yes No

Have you travelled abroad within the past two years? If so, for what purpose (business, pleasure)? Do you travel alone or with
friends/family?:

Education

Education:

Please choose your highest level of education.

Faculty:

Major:

Minor:

Describe about your study:

Name of college/university:

Country:

Country

Graduated Studying

Year of graduation:

List of other schools or trainings

Title/Description of the course:

School:

Country:

Country

Work/Professional Experience

Name of organization/ affiliation/ company:

Type of organization:
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Choose your organization type

Title/Position:

Type:

Full-time Part-time Volunteer

Describe your duties in details (knowledge, skills, abilities required, employees supervised and accomplishments):

Date employed from year:

to year

Company Website:

Additional Personal Information

Partnership status:

Single Married/In civil union Separated

Do you have a partner (or a friend) who also applies for the fellowship?:

Native language:

Languages spoken fluently:

Languages written fluently:

Religion:

What is the combined yearly income (in US Dollars) of

yourself:

your family:

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Health

Have you ever been seriously or contracted with contagious disease?:

Yes No

Do you have any medical condition that requires, or may require, one of the followings during your stay in Thailand

Renal dialysis:

Yes No

Hospital care:

Yes No

Residential care:

Yes No
Residential care is long-term care provided in live-in facilities for the aged or for people with physical, sensory, intellectual, or psychiatric
disabilities.

Have you ever used any medication or drug in the past 2 years?:

Yes No

Your Character

Have you been:

convicted:

Yes No

charged:

Yes No

under investigation:

Yes No

for any offence(s) against the law in any country, including Thailand

Have you been:

excluded (refused entry) from:

Yes No

refused a visa by:

Yes No

removed or deported:

Yes No

from any country, including Thailand

Additional Questions

Have you ever practiced Meditation/Observation of Silence before? If yes, regularly? What was the meditation technique? :

Your answer:

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According to you, how does Inner peace contribute to your community? :

Your answer:

What is your ticket price? Please state your departure and arrival destination.:

Your answer:

We provide partial to full sponsorship of airfare and accommodation. Please write a brief statement telling us why you will need
sponsorship, how you can contribute to the project, and how will your participation give benefits to your society?::

Your answer:

Upload your resume

Click Select Files to add resume files into this list.

1. Select files 2. Click to upload files

Submit your application

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