ELECTORAL POLICY AND ADMINISTRATION

APPLICATION FOR INDIVIDUAL MODULES

PLEASE FILL THIS FORM ELECTRONICALLY AND SEND IT TO mepa@santannapisa.it

PERSONAL DATA

PLEASE INCLUDE ALL YOUR NAMES AS WRITTEN IN YOUR PASSPORT OR IDENTITY CARD

Name:

Surname/Family Name

Date of Birth (day/month/year):

Gender: M F Prefer not to say

Place of Birth (City and Country)	Nationality:

_______________________________________________________________________________

PERMANENT ADDRESS

Country:	City:	ZIP code (if any):

Address:	Street Nr.

Email:	International dialling code:	Mobile:

CHOOSE THE MODULE/S YOU WOULD LIKE TO ATTEND (MAX 6)

(if you wish to attend all modules you must apply for the Master programme, through a different form)

1 - Elections and Voting as Instruments of Governance

2 - Electoral Legal and Regulatory Frameworks

3- Electoral Management Bodies

4 - Electoral Systems and Managing Representation

5 - Understanding and Managing Boundary Delimitation

6 - Political Parties, Campaigns, and Political Finance

7 - Electoral Planning and Budgeting

8 - Voter Registration and Identification Systems

9 - Electoral Operations

10 - Marginalized Electorates and Special Voting Programmes

11 - Elections and Technology

12 - Civic and Voter Education

13 - Media and Elections

14 - Electoral Integrity and Malpractice

15 - Electoral Security and Conflict Prevention

16 - Electoral Justice Systems

17 - Electoral Observation, Evaluation and Validation

18 - Policy Advice and Electoral Reform

19-Direct Democracy

EDUCATION

Degree	Field (e.g. law, business, political science etc.)	University Specify name and country	Degree awarded in (YEAR)
Click to select degree type
Click to select degree type

PROFESSIONAL EXPERIENCE

Position	Employer
Current job
Previous job

LANGUAGE

Please note that to attend the MEPA modules you must be fluent in English (at least B2 level).

For more information on how to assess your English proficiency please visit: https://rm.coe.int/CoERMPublicCommonSearchServices/DisplayDCTMContent?documentId=090000168045bb52

Please declare your level of proficiency in English.

Language	Level of Proficiency
English	Select Proficiency Level

Note: Levels of proficiency according to the Common European Framework Reference for Languages :

Basic User (A1 and A2); Independent User (B1 and B2); Proficient User (C1 and C2).

MOTIVATION

Briefly specify how attending some Modules in Electoral Policy and Administration would benefit you (max 2 lines)

TUITION FEES PAYMENT

Will you pay your tuition fees? YES NO

IF NO, please indicate which organisation will cover your tuition fees

I certify that the information given in this form is complete and accurate to the best of my knowledge. I am aware that any false or misleading information will result in my denial of admission or cancellation of registration following enrolment.

Date Wednesday, 15 July 2020