PERSONAL DETAILS
SURNAME
NAMES (Full names)
TITLE (e.g. Mr, Ms, Dr) / Date of Birth
Preferred name
Citizenship / ID / Passport no.
Country of residence / Gender / Male / Female
CONTACT DETAILS
Residential address / Postal address
Cellphone / Landline
Fax
E-mail address
Special needs, eg. visual / hearing / physical impairment or other. Please specify, with details.
Dietary requirements, eg. vegetarian / halaal / kosher or other. Please specify, with details.
Are you an Arterial Network member? YES/NO
EMERGENCY CONTACT
Name & Surname
Relationship
Cellphone / Landline
LANGUAGE PROFICIENCY. Please tick your proficiency in each of the languages listed.
Speak / Read / Write
1st:
2nd:
Other:
QUALIFICATIONS.Please list only tertiary institutions and highest achieved qualifications.
PROFFESSIONAL/CAREER DEVELOPMENT
What organisation are you currently working with?
What position do you currently hold?
Number of years in this position? Less than 5 years / 5 – 10 years / More than 10 years
Please provide a short description of your responsibilities?
Please list your 3 most relevant previous professional management positions.
Institution / Position / Period
Institution / Position / Period
Institution / Position / Period
Please list 3 most relevant professional associations/networks within the arts, culture, creative industries, for which you hold membership or a leadership position.
Organisation / Position / Period
Organisation / Position / Period
Organisation / Position / Period
Please list the titles and dates of any published work you have authored - articles, chapters, books – or papers you have written or presented.
Publication / Title /
Topic / Publication date
Publication / Title / Topic / Publication date
Publication / Title/Topic / Publication date
Please write your personal and professional profile, max 200 words.
I agree for this profile to be used by AFAI for promotional, media and reporting purposes. Please tick ____.
MOTIVATION
Why do you consider yourself to be a Cultural Entrepreneur in your local cultural and creative sector? Please provide at least one example where you have demonstrated such competency.
Why are you a suitable candidate for Cultural Entrepreneurship training course?
What are your expectations of this course and how it will benefit you personally and professionally?
What do you envisage yourself bringing to this course in terms of your work experience, expertise and personal contribution?
ASSIGNMENT
Please prepare an essay of no more than 3 pages (or 1000 words) on the following topic:
The challenges, priorities and possibilities of Entrepreneurship models in the cultural sector in my country, and what needs to be done in these areas to realize the sector’s potential.
TERMS AND CONDITIONS
SCHOLARSHIPS
Full scholarships will be made available to at least 20 successful applicants.
A scholarships will include:
- Return economy flights from the African country of origin to Cape Town, South Africa
- Airport shuttle transfer in Cape Town only. Airport shuttle transfer in African country of origin is not included.
- Maximum eleven nights’ bed and breakfast accommodation in Cape Town
- Lunch and supper, or per diem equivalent, on training days.
- Daily transport between accommodation, training facility and on field trips.
- Visa fee where relevant. Note that this will only be reimbursed upon submission of an official receipt from the relevant visa authority. No travel costs incurred in obtaining a visa will be reimbursed.
- Course fees, training manuals and all training material.
- Applicants must be high-level leaders within the African creative sector, in civil society or governmentor hold positions in the public sector
- Anyone may apply but in the final selection, preference will be given to those under 40 years of age, to women and to African nationals living in Africa
- Applicants must demonstrate excellent spoken and written English.
- Professional experience should include a minimum of five years within the arts and culture sector, and should have experience in management and coordination of projects, fundraising and financial resource management, strategizing and the implementation of policy, as well as strong research, writing and presentation skills.
- Applicants are to submit an ESSAY of no more than 3 pages (or 1000 words) on a topic stated in the application form.
- At least two reference letters must be submitted in support of this application.
- agree that their names and information pertaining to their professional profile may be used for African Arts Institute promotional, marketing and reporting purposes.
- ensure their availability and commitment to participate in an intensive training workshop scheduled for the period Monday 15 June -24 June 2015 in Cape Town, South Africa.
- ensure their availability to travel to accommodate course dates
- ensure that they are in possession of a valid passport for travel purposes for the duration of the course
- ensure that they are able to obtain a visa, where necessary, to enter South Africa in time for the commencement of the course and for its full duration.
- Shortlisted candidates will be contacted by Friday15 May 2015. Final selection will be published by Friday 22 May 2015.
- Successful candidates must accept and confirm attendance, in writing, by Wednesday 27 May 2015.
- Cancellation by successful candidates less than 10 working days before the start date, or following the start date will result in the candidate being held liable for any travel and/or accommodation costs incurred as well as any travel and/or accommodation cancellation costs incurred.
I, THE APPLICANT,
- acknowledge that the African Arts Institute does not accept responsibility for damage or loss in respect of property of the applicant brought to the African Arts Institute by the applicant.
- do hereby indemnify the African Arts Institute in respect of any damages caused by the applicant to the training premises or to the property of third parties, as a result of the applicant’s actions either whilst on the premises or whilst engaged in any activity related to the African Arts Institute.
- undertake, during the period during which I am a participant, to be bound by the rules and regulations of the African Arts Institute for the time being in force, including the rules and regulations of any residence, club or society to which I may be admitted or become a member and by any requirements or conditions imposed by the African Arts Institute on me as a prerequisite for training participants with the Institute.
- certify that the information provided in this form and all supporting documentation is accurate and complete and acknowledge that any false information may result in disciplinary proceedings being taken against the applicant.
- Non-attendance without reasonable cause will result in immediate exclusion from the course.
- Non-attendance will result in the learning partner being held liable for any travel and/or accommodation costs incurred as well as any travel and/or accommodation cancellation costs incurred following the participant’s exclusion from the course.
- Amendments to this contract may only be made with the written consent of the African Arts Institute.
- The African Arts Institute reserves the right to change timetables, course commencement dates, postpone or cancel tuition in any course/conference initially advertised and offered, on the basis of insufficient demand or on any other reasonable ground.
- Learning partner agrees to be bound by the rules of due performance. The African Arts Institute reserves the right to exclude the learning partners details from any published results and to withhold any certificate of successful completion if due performance requirements have not been met.
I hereby certify that the information provided in this contract is accurate and complete in all respects.I confirm that I have read and undertaken the terms and conditions of this contract, and that I agree to be bound by them.
______
Signature of Applicant / ______
Date of signature
Kindly scan and email back to the African Arts Institute,