Caucasus Youth Leadership Program (CYLP)
Youth Entrepreneurship Program 2017
Georgia
Mentor Application
Application Deadline: Wednesday, July 12, 2017
Include a copy of your passport and your CV
About you:
Last (Family) Name ______
First Name ______
Middle Name ______
Nickname ______
Male ______Female ______
Birth date: Day ______Month ______Year ______
Address______
City, Postal Code______
Mobile Phone ______
Email ______
City and Country of Birth ______
Country of citizenship or permanent legal residence______
About your education:
Highest Degree/Diploma earned: When (month/year) ______School/Institution name: ______
Location (town/city) ______
How many years have you studied English? ______
Do you speak any other languages besides your native language and English? Which ones?
______
Have you ever lived and/or studied in the United States or in another country? ______
If yes: Where, when, why? ______
About your current employment:
Name of Employer/School: ______
Address: ______
Principal/Supervisor’s Name ______
Principal/Supervisor’s Mobile Phone ______Email: ______
Your Job Title: ______How long at this job: ______
What are your specific job responsibilities? If a teacher, what subject(s) and grade level(s) do you teach? ______
______
Please describe the activities (extracurricular, community, hobbies, clubs) in which you participate, how long you have been involved with each, any awards or honors. Use additional space as needed.
What kinds of programs, events, or activities have you participated in that serve or involve youth in your community? What did you do specifically?
How do you think a Caucasus regional identity can help your country address economic challenges in the 21st century.
Essay Questions
Please compose a statement of interest of at least 250 words that outlines your interest in serving as a mentor and chaperone for Georgian youth traveling to the United States. You may discuss why you are interested in entrepreneurship and the development of entrepreneurship among youth in Georgia? How can cross-border or rural entrepreneurship program benefit Georgia? Where do you see yourself and the program participants in 10 years?
This Application is free of charge and may be duplicated.