BRAC Internship Application Form Personal Information Name: Md.

Tasawoof Bin Faroque Permanent Address: Karimjong, Kishorjong Correspondence Address: 6/1, Nandan Apt. 1, South Kallayanpur. Country of Residence: Bangladesh Email: tasawoof@gmail.com Internship Details Where did you hear about BRAC: Internship Type (use inside the box): [ ] BRAC Internship [ ] Voluntary Work for Professionals [ ] Placement as a Research Fellow (ex: Fulbright) Please visit Available Internships and mention the internship placement option you are applying for: Reason for applying in this placement: (describing how you can add value to this project)

Gender: Male Date of Birth (dd/mm/yyyy): 26/06/1989 Nationality: Bangladeshi (by birth) Passport No: Contact Number: +88 01670049201 Fax:

Period:

From (dd/mm/yy)

To (dd/mm/yy)

Personal Statement Please state in not more than 800 words why you want to do an internship with BRAC and the programme, if specified, and its relevance to your area of interest. Also explain your expectations from this internship, what value you can add to BRAC as an intern, and how this placement will further your development.

Applicant Background Getting around Bangladesh Knowledge of Bangla is useful though not necessarily essential. Are you proficient in Bangla? Yes [] No [ ] If yes, please tell us about your level of proficiency. A = Fluent Speaking B = Advanced Listening C = Intermediate Reading D = Basic Writing

What challenges do you think you might face when in Bangladesh?

Skills and Experience Do you have experience in any of the following areas? Area Advocacy Research Teaching Training Proposal & report writing Photography Film Making Graphics Design Field Work Social work Fundraising IT Management Material development Publications Other Details of experience (if you have a background in relevant area))

Notification of Constraints Internship/volunteer placements involve extensive travel using public transportation around rural Bangladesh, exposing one to harsh climate and offering limited facilities. If you have any medical conditions that might affect your ability to spend time in the field during your internship placement, please explain below:

All accepted interns must provide evidence of health insurance during orientation. References Students must provide contact details of two academic referees. Volunteers/Professionals should provide contact details of professional and/or academic referees (as is relevant) and additionally may be required to submit a letter of recommendation from one of the referees. Reference 1 Name: Organization: Email: Telephone: Fax: Relationship: Reference 2 Name: Organization: Email: Telephone: Fax: Relationship:

Please attach a copy of your Resume with this application form and send us at internship@brac.net. Mention the name of placement in the subject of the e-mail.