Clone of [ENCRYPTED] Application Form for Shelter City Netherlands 2025

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IMPORTANT

Before you proceed, please ensure that you are in a safe location, using a secure device, and accessing this through a secure connection.

The questions in this application may require you to disclose personal information which could lead to or increase any risk of threat against you. Please exercise caution when filling out and submitting this application.

Resources

We recommend looking at the following resources on security:

Digital First Aid Kit: https://digitalfirstaid.org/

Security-in-a-Box: https://securityinabox.org/en/

Encrypted form

This is the encrypted version of the form.

Note: If you submit a non-encrypted form, you will automatically receive a copy of your application. However, if you submit an encrypted form, although we will be notified of your submission, you will not receive a copy of your application.

Deadline & contact information

Application forms must be submitted by 2 August 2026 at 23:59 CEST (Central European Summer Time).

If you have any questions about this application form or Shelter City Netherlands, please contact the Shelter City Team at info@sheltercity.org or sheltercity.netherlands@protonmail.com.
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About the personal data you provide in this form

Personal data submitted via this form are handled by Justice & Peace Netherlands, Riviervismarkt 4, 2513 AM, The Hague, the Netherlands. You can reach Justice & Peace by phone: +31 70 763 1499 or via email: info@justiceandpeace.nl. Our website can be consulted at the following address: www.justiceandpeace.nl.

The online application form is operated by JotForm.com, a US-based company. The form is end-to-end encrypted, meaning that any data submitted through it is encrypted in transit from one end to the other. JotForm.com may, however, still have access to some submission information such as the date of submission, the physical address and the technical description of the device from where the submission was made. This information may be stored in JotForm’s servers and is subject to JotForm’s Terms of Use and Privacy Policy.

How your data is used & stored

Personal data you provide Justice & Peace is used exclusively for the purpose of selecting Shelter City guests and properly implementing Shelter City. Personal data are processed in accordance with the European Union’s General Data Protection Regulation. Personal data are shared with the same purpose and only with authorized Justice & Peace personnel and with the Shelter City Selection Committee.

You have rights over the personal data you submit to Justice & Peace: at any time, you can request access to and rectification or erasure of your personal data. You can request the restriction or object to the processing of your personal data. You also have the right to withdraw consent at any time. Finally, you have the right to lodge a complaint with the Dutch data protection supervisory authority, Autoriteit Persoonsgegevens, which can be contacted here.

Justice & Peace does not generally keep the personal data of applicants when:

the personal data is no longer necessary in relation to the legitimate purpose of the proper and fair implementation of the Shelter City programme,

applicants withdraw consent and there is no other legal ground for the processing,

applicants object to the processing and there are no overriding legitimate grounds for the processing,

Justice & Peace realizes that the personal data have been unlawfully processed, or

when the personal data must be erased for compliance with a legal obligation in the Netherlands.

By submitting this application, you consent to the processing of your personal data by Justice & Peace in accordance with the provisions explained above.
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Temporary relocation in the Netherlands

Shelter City Netherlands is an initiative for short and temporary relocation for 3 months financed by Justice & Peace Netherlands, the Dutch Ministry of Foreign Affairs, host organizations and municipalities.

Selection process & Shelter Cities

An independent Selection Committee will select the final candidates for Shelter City in the Netherlands and determine which Dutch city they will go to, namely Amsterdam, Deventer, The Hague, Groningen, Eindhoven, Haarlem, Maastricht, Middelburg, Nijmegen, Rotterdam, Tilburg, Utrecht, Zwolle, or Amstelveen.

Note: Additional factors will be taken into consideration in the final round of selection, such as the added value of a stay in the Netherlands as well as gender, geographic, and thematic balance. Please note that only under exceptional circumstances are we able to accept human rights defenders currently residing in a third country.

Programme in the Netherlands

A monthly stipend, accommodation, health insurance, visa and return flight tickets to the Netherlands are provided to human rights defenders selected for the initiative.

During their stay in the Netherlands, each human rights defender is independent and responsible for their own programme. In establishing this, human rights defenders will be supported by Justice & Peace and the hosting organization in the city. Justice & Peace will also provide mandatory capacity building on topics such as security and advocacy for approximately 10 days. Participants receive personal accompaniment* throughout their stay in the Netherlands.

Human rights defenders should possess a conversational level of English.**

*Accompaniment refers to the support that is provided throughout your stay by the host city.

**By conversational English we mean that participants’ level of English allows them to actively participate in training, speak about their work, communicate with the host city, etc.

Note: If you do not meet these conditions, but would still like to apply for relocation, please contact us at info@sheltercity.org or sheltercity.netherlands@protonmail.com. We can try to put you in contact with other organizations that have relocation programmes with different parameters.
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SAVE YOUR PROGRESS!

If you have difficulty completing your form, please get in touch with us.

Make sure to save your progress as you fill in the form by clicking on the button at the bottom of your screen, as shown in the following pictures below (please scroll down).

On your computer:

On your mobile device:
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1.1 Are you a human rights defender?* This field is required.The term 'human rights defender' is intended to refer to the broad range of activists, journalists and independent media professionals, scholars, writers, artists, lawyers, civil and political rights defenders, civil society members, and others working to advance human rights and democracy around the world.
YESNO
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1.2 Do you use or have considered using a violent approach in your human rights work?* This field is required.
YESNO
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1.3 Are you threatened or concerned about your safety as a result of your human rights work?* This field is required.
YESNO
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1.4 You are looking for the following relocation option. Select the option that applies to you.* This field is required.
I am looking for temporary relocation for a maximum period of 3 months.
I am looking for a longer-term solution to be away from my country.
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1.5 Are you willing and able to return to your country of origin after 3 months?* This field is required.
YESNO
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1.6 Are you willing to begin your stay in the Netherlands in March 2027?* This field is required.
YESNO
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1.7 As part of the selection procedure, we will enquire with the Dutch Embassy in your country/region about your situation and human rights work. Do you consent to this?* This field is required.This will be a confidential enquiry. You will not be required to travel to and/or meet with officials of the Dutch Embassy in your country/region.
YESNO
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Full name:* This field is required.
First Name
Last Name
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E-mail:* This field is required.
example@example.com
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Phone number:* This field is required.
Area Code
Phone Number
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If you are selected, through which method would you prefer to be contacted?* This field is required.If you are not selected, you will receive a notification via the email address indicated earlier.
Email
Signal
Other
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Date of birth:* This field is required.Please write in the format dd-mm-yyyy.
dd-mm-yyyy
Day
Month
Year
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Gender:* This field is required.
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Pronouns:
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Country of citizenship:* This field is required.
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Country of residence / current location:* This field is required.
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Region and city/village of residence:* This field is required.
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Do you have any dependents?* This field is required.Dependents can be your children, spouse, partner, extended family etc.
YESNO
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If you are selected, would you want to bring one (or more) of your dependents?* This field is required.Please be informed that there are very limited possibilities to bring dependents. Please note that your answer does not influence the assessment of your application. However, in case you are selected for the programme, this information will be important for us to prepare for your stay.
Yes, I need to bring my dependent(s) to be able to participate in the programme.
Yes, I would like to bring my dependent(s), but this is not necessary.
No, I would not like to bring my dependent(s).
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Please indicate how your answer will affect your stay and full participation in the programme.* This field is required.100 words maximum.
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Mother tongue:* This field is required.Your native language.
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Level of English:* This field is required.
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2
3
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Beginner
Fluent
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Other languages: * This field is required.
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Level and type of education:* This field is required.
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How did you hear about Shelter City?* This field is required.
Justice & Peace website
Shelter City website
Justice & Peace social media
Shelter City social media
A friend
A colleague
The Dutch Embassy
Former Shelter City guest
Human rights defenders' network
Other
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3.1 What is your main area of work?* This field is required.Please select only one option below.
Business and human rights
Environmental rights
Humanitarian assistance and development
Human rights lawyer
Children's rights
Women's rights and SGBV
LGBTIQ+ rights
Minority rights
Civil and political rights
Freedom of speech/expression
Refugees and armed conflict victims
Conflict resolution and peace building
Detention and slavery
Rights in the digital era
Indigenous rights
Other
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3.2 Please check a maximum of 3 additional boxes below in case they apply to your area of work as well.
Business and human rights
Environmental rights
Humanitarian assistance and development
Human rights lawyer
Children's rights
Women's rights and SGBV
LGBTIQ+ rights
Minority rights
Civil and political rights
Freedom of speech/expression
Refugees and armed conflict victims
Conflict resolution and peace building
Detention and slavery
Rights in the digital era
Indigenous rights
Other
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3.3 Briefly describe (1) your human rights work, (2) the methods and activities that you use and (3) who benefits from your work.* This field is required.250 words maximum.
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3.4 If you work for an organization or are otherwise linked to an organization, please provide the following information.
Name of organization that you work for or are otherwise linked to
Short description of organization
Please Select
Please Select
Less than 10
11 - 20
21 - 50
More than 50
Size of organization
Organization's website or social media link
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3.5 Are you currently employed? If so, can a three-month stay abroad have any adverse consequences on your work situation?* This field is required.100 words maximum. Please note that participants are responsible to ensure they can take a three-month leave with their employer.
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3.6 Please explain how your human rights work at home can be sustained while you are in the Netherlands for 3 months.* This field is required.100 words maximum.
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3.7 Do you or your organization work or have you worked with organizations abroad? Have you travelled abroad for your work? If so, please specify your answer.* This field is required.100 words maximum.
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4.1 Have you, your family or colleagues been facing persecution, including threats or attacks of any kind: physical, psychological, legal, digital*? Please give specific examples with dates (starting with the most recent) and distinguish in your answer between current and past threats.* This field is required.300 words maximum. *Examples may include harassment, arrests, social marginalization, stigmatization, blacklisting, threats by email, phishing emails, website attacked, online defamation campaign, account hacked, etc.
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4.2 What are the reasons why you, your organization or your family are facing persecution? Are they a result of your work and/or related to aspects of your personal identity?* This field is required.200 words maximum. For example: race, class, ethnicity, gender, or sexual orientation.
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4.3 Who do you think is behind the persecutions mentioned under 4.1?* This field is required.100 words maximum. Please describe who they are (government officials, judges, lawyers, members of parliament, union leaders, military officials, journalists, public figures, business, other NGO leaders, colleagues, family members, etc.).
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4.4 Can you explain the impact these threats have on your work and/or your wellbeing?* This field is required.100 words maximum.
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4.5 What have you done in return to protect yourself or your organization? Are there things that still prevent you from protecting yourself or your organization?* This field is required.100 words maximum. Explain any vulnerabilities you might have or obstacles you are unable to overcome.
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4.6 What are you most worried about in continuing your work?* This field is required.100 words maximum. Please be specific in your answer about the concerns that you have (security etc.) and the reason why.
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4.7 Please describe the current situation in your country, focusing on human rights and how this affects your work. Is there any planned event (elections, adoption of a new law etc.) that is likely to affect your personal situation in the coming 12 months? If so, what kind of effect do you think this could have on your security situation?* This field is required.100 words maximum.
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5.1 What would be your main objective while you are in the Netherlands?* This field is required.Your answer will provide us with a better understanding of your needs during the programme. Please note that your answer does not influence the assessment of your application. However, in case you are selected for the programme, this information will be important for us to prepare for your stay.
Rest (for example: recreational activities, psychological support, socialising, sightseeing)
Advocacy (for example: participating in public speaking events, raising awareness, lobbying on human rights)
Networking (for example: connecting with individuals and organizations engaged in the same area of human rights)
Training (for example: receiving training on digital security, taking a short human rights course at a university)
Other
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5.2 Please explain your answer in 5.1 by indicating the kind of activities you would like to do when you are in the Netherlands and how such activities would contribute to your main objective.* This field is required.200 words maximum. We encourage you to think carefully about the objective of your stay and what you would like to achieve from your participation in the programme.
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5.3 Do you feel comfortable speaking publicly about your work as a human rights defender while staying in the Netherlands? What kind of impact can speaking publicly in the Netherlands have on you or your family’s safety?* This field is required.100 words maximum. Some participants prefer being visible and gaining exposure for protection, while some do not. Please clearly indicate your preference. Please note that your answer does not influence the assessment of your application. However, in case you are selected for the programme, this information will be important for us to prepare for your stay.
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5.4 Have you ever received training in security and protection for human rights defenders? If so, please specify the type of training you received and by whom the training was organized.* This field is required.100 words maximum.
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5.5 Is there a need for you to receive training in security and protection for human rights defenders? If so, please specify the type of training you would need and add other training topics that you find very important to receive to support your work.* This field is required.100 words maximum.
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5.6 As part of your human rights work, do you conduct research activities in the field of human rights law?* This field is required.
YESNO
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The T.M.C. Asser Institute is an internationally renowned research centre for international and European law. It fulfils an important role in conducting fundamental and independent practice- and policy-oriented research and in providing a platform for international cooperation and partnering in fields of law at the intersection of academia and practice. Over the years, the Asser Institute has developed strong independent research activities, inter alia in the fields of international and European human rights law. For more information about the institute’s research agenda, see http://www.asser.nl/research/.

Justice & Peace Netherlands and the Asser Institute have established a collaborative relationship to strengthen and support the capacity of local human rights defenders worldwide. In the context of the Institute’s Visiting Researchers Programme, the Asser Institute hosts one Fellow per year for a period of 3 months within the framework of the Shelter City initiative by Justice & Peace. The selected Fellow will carry out a research project during the three-month period and take part in other human rights relevant (research) activities of the Asser Institute. In line with these activities, closer to the end of the three-month period, the Fellow will have to present the relevant research findings in a public or closed event. The Fellow may also participate in other (public) events like lectures or (panel) discussions.

Note: If you are selected as an Asser Institute Fellow within the Shelter City initiative, your stay in the Netherlands will begin in September 2027.
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During the three-month programme, would you be interested and willing to independently carry out a research project that aims to contribute to the improvement of human rights?* This field is required.
YESNO
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Please provide a short synopsis of your plans for the research project.* This field is required.250 words maximum.
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6.1 The duration of the programme is up to 3 months. How do you see your return after having participated in the programme (work situation, income, security etc.)? Please specify any difficulties that you expect to face.* This field is required.200 words maximum.
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6.2 What specific projects do you plan to work on after your return and how do you see the programme contributing to your human rights goals?* This field is required.100 words maximum.
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7.1 Have you ever requested relocation or emergency funding for other programmes? If so, what was the outcome of this request?* This field is required.100 words maximum.
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7.2 Do you consent to us sharing your information with our partner(s) for purposes of providing you with resources and/or training for human rights defenders?* This field is required.
YESNO
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7.3 Do you currently have a passport valid for at least 18 months?* This field is required.Please note that your answer does not influence the assessment of your application. However, in case you are selected for the programme, this information will be important for us to prepare for your stay.
YESNO
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When does your passport expire?* This field is required.Please insert a date.
dd-mm-yyyy
Day
Month
Year
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7.4 Please inform us of any medical conditions that we should know about.* This field is required.100 words maximum. Please note that your answer does not influence the assessment of your application. However, in case you are selected for the programme, this information will be important for us to prepare for your stay.
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7.5 For any additional information you wish to provide, please use the space below.100 words maximum.
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Please provide contact information for at least two references (outside of your organization who are aware of your situation and human rights work). If possible, at least one reference should be from a reputable international organization. If you do not provide any references, your application will not be considered.

Note: References must be individuals whom Justice & Peace can contact to verify your human rights work and are aware of the risk that you are facing. These individuals will be contacted via email.
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8.1 Reference 1* This field is required.
Name
Job title
Organization
Country
Email address
Phone number
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8.2 Reference 2* This field is required.
Name
Job title
Organization
Country
Email address
Phone number
Should be Empty: