Download the Appendix of Application Form and Questionnaire in
PDF format (85 KB) and Word Document (46 KB)

Download the Letter of Willingness in
PDF format (48 KB) and Word Document (25 KB)

APPENDIX OF APPLICATION FORM
FOR
Regional Workshop on Accessible Web-based Information Networking

Please submit all pertinent documents and your answers to this questionnaire in typewritten form together with your Fellowship Application Form.

TITLE Mr.
Ms.
Mrs.
Dr. 		NAME (captical letter)  
GENDER MALE
FEMALE 		FAMILY NAME GIVEN NAME MIDDLE NAME
BIRTH DATE (Day/Month/Year):

PASSPORT NUMBER:

PASSPORT EXPIRY DATE (Day/Month/Year):

HOME ADDRESS:

 

TELEPHONE NUMBER (Country Code/Area Code/Number):

FAX NUMBER (Country Code/Area Code/Number):

NAME OF THE ORGANIZATION:

 

ADDRESS:

 

TELEPHONE NUMBER (Country Code/Area Code/Number):

FAX NUMBER (Country Code/Area Code/Number):

 

E-MAIL ADDRESS:

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DISABILITIES
(IF ANY)

YES.
NO.

TYPE OF DISABILITIES Physical Disability
Hearing Disability
Visual Disability
Intellectual Disability
Mental Disability
Other
  USAGE OF ASSISTIVE DEVICES: YES NO
DETAIL OF YOUR ASSISTIVE DEVICES:
  1. Power/electronic wheelchair ( Wet battery Dry battery)
  2. Wheelchair
  3. Crutch (es)
  4. White cane
  5. Other (                                )
NECESSITY OF A PERSONAL ASSISTANT FOR THE TRAINING:
  1. YES => (Details)
  2. NO
NECESSITY OF A SIGN INTERPRETER FOR THE TRAINING:
  1. YES => (Details)
  2. NO
DIETARY REQUIREMENT (IF ANY)

I hereby certify that all the provided information is correct, accurate and complete to the best of my knowledge.

In the event that I suffer injury, illness or death during the course of my participation in the program/course, I shall hold the Royal Thai Government, the Government of Japan, Japan International Cooperation Agency (JICA) and/or the Asia-Pacific Development Center on Disability harmless and without any liability whatsoever for compensation towards myself, my legal representatives and/or my heirs. Should I cause any person loss of property, injury, illness or death during the course of my participation in the program/course, I shall be fully responsible and liable for the said person without reference whatsoever to the Royal Thai Government, the Government of Japan, Japan International Cooperation Agency (JICA) and/or the Asia-Pacific Development Center on Disability.

 

 

SIGNATURE OF NOMINEE

PRINTED NAME OF NOMINEE (________________________________)

DATE:

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QUESTIONNAIRE

Q. 1 Could you explain your work responsibility regarding your organization's website? (e.g. Are you a webmaster, programmer, web editor, or contents provider, etc?)
*URL of your responsible website http://__________________________

 

Q.2 Are you familiar with the term "web accessibility"?
If so, please explain.

 

Q3 Do you think web accessibility is important for persons with a disability?
If so, please explain why?

 

Q.4 How familiar are you with HTML, XHTML, XML and CSS?
Are you able to edit these languages by yourself?
Please answer the following questions?

4.1: What do XHTML and CSS stand for?

 

4.2: What is the first sentence you must write when you make a website in XHTML according to W3C Guidelines?

 

4.3: Please write these "Elements" in XHTML when you make website?

e.g.  	Paragraph: <p></p>
	Heading:
	Link:
	Alternative text to image:

 

Q.5 What is the website strategy of your organization for information networking?

 

Q.6 Can you recommend a website that you rely on most when you collect disability-related information?

 

Q.7 Have you ever visited the APCD website?

1) Often		     2) A few times		3) Never

 

Q.8 What kind of information do you expect APCD to have in the website?

 

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Date: __________________

Letter of Willingness

_______________________________________________ (Organization's name) would be so happy to show our willingness to promote regional web-based disability information networking in cooperation with the Asia-Pacific Development Center on Disability (APCD) in accessible format.

We highly value information accessibility for persons with disability in order to promote empowerment and a barrier-free society for persons with disability in the Asia-Pacific region.

Signature : ______________________

Name of Representative: ______________________

Organization : _________________________________________________________________

Address : _________________________________________________________________ _________________________________________________________________

Telephone : _____________________

Fax : _____________________

E-mail : _____________________

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