APPLICATION FORM FOR KOICA TRAINING PARTICIPANTS

Korea International Cooperation Agency

HQ & ICC: 418 Daewang Pangyo-ro, Sujeong-gu, Seongnam-si, Gyeonggi-do, Korea

Tel: 82-31-777-2600 Fax: 82-31-777-2603 E-mail: training@koica.go.kr, http://www.koica.go.kr

Ⅰ. TITLE OF COURSE

Economic Empowerment For Rural Women

Ⅱ. PERSONAL DATA

Name(passport) First Johanna Middle Elizabeth Last(Sur) Manrique

Hernandez

Date of Birth Month November Day 06 Year 1984

Sex □M F Marital Status Single

Nationality Colombian Religion Catholic

Passport Number P061346 Airport of Departure El Dorado,

Bogotá, Colombia

Home Address Diagonal 45 sur No 55-73 Venecia

Tel. No. 57 - 01 - 2306746

Country code area code number Fax No.

- -

country code area code number

Mobile No. 312-4521458 E-mail jemanriqueh@gmail.com

Emergency Contact Name Efraín Manrique Tel. No. 57 +01+ 2306746

Ⅲ. EMPLOYMENT

Present Position Management Department Economics

Name of organization Grupo Textil 3R Address Calle 10A No 72A-13

Tel. No. 57 - 01 - 7026765

country code area code number Fax No.

- -

country code area code number

Type of Organization □Governmental/Public Private □International □Other

Term of Employment from 28th March to present

Describe your present duties Management, accountability

Ⅳ. OTHERS

1. Describe any themes, topics and places of interest you would like to see in this training course.

The main reason because I am applying it is because It has been of my greatest interest every

topic related with inequality and poverty. I have recognized that aside from inequality related

with the way the sources are distributed, the concentration of industry activity in few cities, the

composition of the employment mainly in activities of the primary and third sector and some

institutional shortcomings; there are also a huge difference in living conditions between urban

and rural zones. Particularly, living in rural zones it has become difficult not only for

infrastructure deficiencies, low job opportunities and low quality in education, but also because

of violence, the territorialism and influence of landlords. To establish a comparison with other

countries in the world, this course may let me have a global vision about the situation among

both areas and the differences between first and third world. Also, I have been interested in

topics related with women and feminism and specifically the way women has to face life and

raising of children in rural places, it means, living conditions, poverty, inequality in gender terms

and low quality of welfare.

2. Any restrictions on food and/or behavior due to health or religious reasons?

□Yes >> □Beef □Pork □Fish □Others( )/ No

3. Are you allergic to any medication or food?

□Yes ( )/ No

Ⅴ. CAREER

Career over the past 5 years:

Name of Organization From To

Position/ Responsibilities month/year month/year

Contexto Newspaper 02/05 04/07 Economic and politics editor of the

newspaper Contexto.

SeInforma Canada 02/07 08/09 Economic Editor of the newspaper

Seinforma.ca.

National University of

Colombia 02 /08 04 /08

Assistant for new students in Economics

Faculty/ To assist to the teacher in every

activity, to direct induction and to teach

some contents related with economics,

making essays and use of different software.

National University of

Colombia 05 /08 07 / 08

Formulating questions for ECAES

preparation in Economics Faculty/ To

prepare questions for the students to be

used as a tool for ECAES training. These

questions were about macroeconomics,

Colombian History of Economics and

Economic Thought.

Centre for Development

Research (CID) 03/09 06/09

Theme assistant/ To prepare questions for

National Survey to Displaced Population, to

formulate indicators to measure economic

and living conditions for displaced people

included and not included into the RUPD

registration and create indicators for

economic assessment of the heritage

before displacement in order to quantify and

estimate the amount of money for reparation

of the victims of war conflict. I had to study

topics related with differences among urban

and rural living conditions and situation of

women as head of family, as main economic

agent of the rural area and as victims of the

conflict. Finally I had to analyze the

information of the survey and make reports.

Banco de la República 06/09 08/09

Reviewing student essays about history of

the Republic Bank and how the monetary

Politics is managed, tools and implications of

any decision taken in the Central Bank.

In 2010 I travelled to England were I took the English course. Even though I worked, It is not

relevant enough to be referenced.

Grupo Textil 3R 03/11 Present

Co-management. I have to create planning,

operative and advertising strategies for the

enterprise, prepare economic reports and

rearrange the business plan for the next

months.

Educational background

Name of Institution From To

Field of Study and Degree month/year month/year

National University of

Colombia 08 /02 08 /07 Economics

National University of

Colombia 08/07 / Magister in Economics

/ /

Foarmer training experiences in Korea (KOICA) or other countries: Yes □No

Name of Institution From To

Field of Study and Degree month/year month/year

Language in London 03/10 01/11

This course was taken in London, UK for 9

months. I took General English, Conversation

English, Business English, Cultural

Experience, One to One lessons and IELTS

preparation.

/ /

/ /

Ⅵ. LANGUAGE PROFICIENCY

English:

Excellent Good Fair Poor Remarks

Listening x 6.5

Speaking x 6.5

Writing x 6.0

Reading x 7.0

Native Language : Spanish

Other Languages :

In case you speak English as a foreign language, it is required for you to certify

your English proficiency. Please indicate your English Proficiency Test scores:

□ TOEFL: □ TOEIC: Others: IELTS 6.5 (□IBT, □CBT, □PBT) score score score

Ⅶ. MEDICAL REPORT 1 (to be completed by an authorized physician)

Name of Applicant: Johanna Elizabeth Manrique Hernandez

Age: 26 Sex: Feminine Height: cm Weight: kg

Blood Type: Blood Pressure: / mmHg

EKG □Normal □Abnormal

Chest PA □Normal □Abnormal

Urinalysis □Normal □Abnormal

Diabetes □Positive □Negative

Hepatitis B □Positive □Negative

Hepatitis C □Positive □Negative

Syphilis □Positive □Negative

AIDS □Positive □Negative

Infectious disease □Yes □No

Endemic disease □Yes □No

Pregnancy test □Positive □Negative

1. If the applicant has a history of illnesses or disorders during the past 5 years, please describe

the treatment and present status.

2. What opinions do you have about the overall health condition of the applicant in regards to

him/her carrying out an intensive training course away from his/her home?

Name of Clinic:

Address of Clinic:

Name of Physician:

Date: Signature of Physician:

Ⅷ. MEDICAL REPORT 2 (to be completed by an applicant)

1. Present Status

(a) Do you currently use any drugs for the treatment of a medical condition? (Give name & dosage.) (X ) No ( ) Yes >> Name of Medication ( ), Quantity ( )

(b) Are you pregnant?(Female only) ( X) No( ), Yes ( months )

(C) Please indicate any needs arising from disabilities that might necessitate additional support or facilities. ( - )

Note: A disability does not lead to dismissal or exclusion from the program. However, upon the situation, you may be

directly inquired by the KOICA official in charge for a more detailed account of your condition.

2. Medical History

(a) Have you had any significant or serious illnesses? (If hospitalized, give place & dates.)

Past: (X ) No ( ) Yes>>Name of illness ( ), Place & dates ( )

Present: (X ) No ( ) Yes>>Present Condition ( )

(b) Have you ever been a patient in a mental hospital or have been treated by a psychiatrist?

Past: (X ) No ( ) Yes>>Name of illness ( ), Place & dates ( )

Present: (X ) No ( ) Yes>>Present Condition ( )

(c) High blood pressure

Past: (X ) No ( ) Yes

Present: (X ) No ( ) Yes>>Present Condition ( ) mm/Hg to ( ) mm/Hg

(d) Diabetes (sugar in the urine)

Past: (X ) No ( ) Yes

Present: (X ) No ( ) Yes>>Present Condition ( )

Present: (X ) No Are you taking any medicine or insulin? ( X) No ( ) Yes

(e-1) Past History: What illness(es) have you had previously?

( ) Stomach and Intestinal Disorder ( ) Liver Disease ( ) Heart Disease ( ) Kidney Disease

( ) Tuberculosis ( ) Asthma ( ) Thyroid Problem

(X ) Infectious Disease >>> Specify name of illness (Hepatitis A) )

( ) Other >>> Specify ( )

(e-2) Has this disease been cured?

(x ) Yes ( ) No (Specify name of illness) :

(x ) Yes Present Condition: ( I am totally recovered from Hepatitis A and I am healthy) )

I certify that I have read the above instructions and answered all questions truthfully and completely to the

best of my knowledge.

Date: September the 30th of 2011 Signature of Applicant:

Ⅸ. APPLICANT'S RESPONSIBILITIES

If accepted as a participant, I agree:

1) to participate in the training course to the best of my ability and abide by the rules of the training institute, university, or college in which I undertake training;

2) to refrain from engaging in political activity or any form of employment for profit or gain;

3) to return to my home country upon completion of my training course and to resume work in my country;

4) not to extend the length of my training or my stay for personal conveniences; 5) not to bring any family members (dependents) to Korea or country of training; 6) to accept that KOICA is not liable for any damage or loss of my personal property; 7) to accept that KOICA will not assume any responsibility for illnesses, injuries, or

death arising from extracurricular activities, willful misconduct, or undisclosed pre-existing medical conditions; and

8) to carry out such instructions and abide by such conditions as may be stipulated by KOICA in regards to the training course; and

9) to allow KOICA to collect information about me and to pass that information onto other relevant parties if necessary

I fully understand that my status as a participant may be terminated if I fail to

make satisfactory progress or for any other reason determined by KOICA. Applicant's Name: Johanna Elizabeth Manrique Hernández

Signature:

Ⅹ. OFFICIAL NOMINATION

The Government of officially nominates

(Name of Country)

for participation in

(Full Name of Applicant) (Name of Training Course)

as organized by the Korean Government(KOICA), and certifies that:

1) all information supplied by the applicant is complete and correct;

2) the applicant has an adequate knowledge of and/ or expertise in the training field; and

3) the applicant has a sufficient proficiency of spoken and written English to enable him/her to undergo the training course.

Name of Organization:

Position/Title:

Name of Authorized Official:

Date: Signature: