NEF Ambassadors Application

NEF Ambassadors Application

NEF Ambassadors Application

Instructions: This application form has the following 6 sectionswhich must be completed in full.

Section 1: Provide contact information and basic bio-data.

Section 2: Provide a professional photo. Photograph (face and shoulders only & must be high-resolution)**Please copy and paste photograph in the designated spot and replace the placeholder cartoon picture.

Section 3: Prepare a two-minute video responding to the questions. The video must not exceed 2 minutes. You must upload your video to YouTube and provide the YouTube link in the application form. Please make the video public.

Section 4: Prepare answers to questions in no more than 250 words each.

Section 5: Provide your signature and consent.

Section 6: Provide your CV or resume.

Submission Instructions:

1. Make sure that your application form is in one file. You must submit it as a PDF document. Applications that do not follow this naming convention will not be accepted.
2. Rename this application form to CountryofCitizenship - Lastname, Firstname Middlename.docx
3. Send the completed application

Deadline for submission:3 September 2017

Open to:Algeria, Angola, Burkina Faso, Burundi, Central African Republic, Cape Verde, Comoros, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Guinea Bissau, Lesotho, Liberia, Libya, Madagascar, Mauritania, Morocco, Mozambique, Namibia, Republic of Congo, Sao Tome and Principe, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Swaziland, Tunisia, Zambia, Zimbabwe

Section 1:Contact Informationand Bio-Data

Last Name:Click here to enter text.

First Name:Click here to enter text.

Middle Name:Click here to enter text.

Title:Mr☐Mrs☐ Ms☐Dr. ☐Other Title:Click here to add title.

Gender: Male ☐Female ☐

Date of Birth:DD/MM/YYYY

Nationality (Country of Citizenship):Click here to enter country name.

Country of Residence (In which country are you currently residing?):Click here to enter country name.

Mailing Address:Click here to enter text.

City:Click here to enter text.

State/Province/County (N/A if not applicable): Click here to enter text.

Country:Click here to enter text.

Postal Code (N/A if not applicable): Click here to enter text.

Employment Status:Student ☐Professional☐Academic☐

Name of organization or company affiliated to:Click here to enter text.

Email:Click here to enter text.

Phone Number (Include country extension):Click here to enter text.

SkypeID:Click here to enter text.

Section 2:Photo

Please copy and paste your photo here. Your photo will replace this placeholder photo. You can right-click on the photo below and choose the option to “Change Photo.” You will then select your own photo to place here.

Section 3:Youtube Video Link

We want to get to know you better and to do this we would love to hear you speak to us by video. The video does not have to be professionally done (it can be taken with a camera or phone, for example), but the picture and sound should be clear. Your video will be 2 minutes at the most.

In the video, please clearly:

a)Tell us why you want to be a NEF Ambassador?

b)What special skills and contributions would you bring to your role as NEF Ambassador?

You can upload the video via YouTube. Please paste the link here:

Click here to enter text.

Section 4:Questions

Answer the following questions in no more than 250 wordseach in the space provided:

1. What do I want to learn from and share at the NEF Global Gathering?

Click here to enter text.

1. What are at least three strategies I will use to share this knowledge with at at least 20k people when I return to my community?

Click here to enter text.

1. Please provide one to two online links that demonstrate an active presence online. Describe the link(s) and its significance. How many followers did you have and what strategies did you use to engage your followers? (max 150 words – links can include Face-book, YouTube, Twitter, blog, Instagram, and other mainstream so-cial media outlets).

First link: Click here to enter text.

Second link: Click here to enter text.

Section 5: Signature

By submitting this application, I agree that my name, photo, video and other information may be used on the NEF promotional materials and social media platforms and grant permission to AIMS and the Next Einstein Forum to use them.

I hereby certify that the information submitted on this form and in the attached documents is true and accurate to the best of my knowledge.

Signature:

Please note that if you do not have an electronic signature, you can print, sign and scan application form.

Date: DD/MM/YYYY

Section 6: CV or Resume

PLEASE INSERT YOUR CV HERE and check that you have labeled this file correctly before submitting your application.

- End of Form -

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