The India Fellows Program

INDIA FELLOWS PROGRAM

APPLICATION FORM FOR

THE INDIA FELLOWS PROGRAM

Welcome to the online application for the India Fellows Program! Before beginning the applications, please review the "How To Apply" section of our website for eligibility criteria and application instructions.All applications must be received by5:00 PM GMT (Greenwich Mean Time) / 10:30 PM IST ( Indian Standard time) on 23rdSeptember 2013.Late or incomplete submissions will not be considered. If you havequestions or if you are having technical difficulties, please read theFrequently AskedQuestions -if you still have questions after reading the FAQ, you may email .

The application for the India Fellows Program consists of:

Background information on both you and your work in social change

Your responses to the application questions

Your work history and resume/CV (to be uploaded)

2 professional references

Please complete this application in English. Fields marked with an*are required. Please limit your responses to the given character/word limits for each question. It is stronglyrecommended that you compose your essays in a word processor with a charactercount feature.

Submit your application in one of the following ways:

Via Email:

Via Mail:

Acumen India Office

203 Dheeraj Plaza, Hill Road, Bandra West, Mumbai, 400050, India

Next steps after submission of application:

Update to all applicants – mid September 2013

Phone interviews – late September to early October 2013

Selection Conference (in-person interviews) – 26 October 2013

Final Selection of 20 Fellows – November/December 2013

First Seminar – January/February 2014

CONTACT INFORMATION

First Name* ______

Last Name* ______

Email Address* ______

Primary Phone* ______

Secondary Phone______

PERSONAL INFORMATION

Fellows must demonstrate a long-term commitment and concrete connection to India.

What is your nationality? * ______

For how long have you lived in India? * ______

What is your gender?

(circle one) Male Female Other

SOCIAL CHANGE WORK

We are looking for individuals who are not just dreamers, but they are do-ers. Each selected Fellow must have a demonstrated commitment to social change through long-term experience contributing to poverty alleviation in their region. Fellows come from across sectors (i.e. for-profit, social enterprise, NGO, government sectors, etc.) and work on a variety of issues (i.e. education, renewable energy, activism, etc.) but all are currently engaged in a project or organization that seeks to create positive social impact.

Note: If you are involved in multiple projects that create social impact, describe the project that takes most of your time.

What is the name of the organization you work for or founded? *

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In one sentence (150 characters max), describe your social change project or organization. *

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In one or two words, what is your project’s main area of focus? *

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If you have a website for your organization, please include the web address here:

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What is your title at this organization? *

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What are your specific responsibilities at this organization? (Note: If we asked your CEO or Board of Directors what your role is at your organization, how would they describe your responsibilities on a day-to-day basis?) Your response should be no longer than 100 words*

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What goals do you hope to accomplish by the end of this year? (Note: Tell us about the goals that you personally are responsible for achieving this year. Don’t describe your organizational goals, but rather your specific objectives.) Your response should be no longer than 200 words*

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For how long have you been leading this project/organization? *

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What is your time commitment to this project or organization? *(check one)

Full-Time – spend more than 40 hours a week on this organization.

 Part-Time – I spend less than 40 hours a week on this organization.

If you answered “Part-Time” to the question above, in no more than 50 words, please describe what your other time commitments are:

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Social Impact Metrics

What is the social impact you are making through this project/organization? Quantify your impact with a number and provide a brief description. Includeat least one, andup to fourimpact numbers.

Example:

Impact Number- 1000

Impact Description- Number of youth who have completed our 12-month entrepreneurship program.

Impact Number: ______

Impact Description: ______

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Impact Number: ______

Impact Description: ______

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Impact Number: ______

Impact Description: ______

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Impact Number: ______

Impact Description: ______

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WORK EXPERIENCE

Total number of years of work experience*______

What is your main area of expertise? * ______

Work History*

Please fill out the below fields forno more than fourrelevant professional experiences which you feel demonstrates your capacity to lead, or your dedication to the region, and your commitment to bringing about positive social change.

Title ______

Organization ______

Location (City, Country)______

Start Date ______

End Date ______

Total Time Period ______

Key Responsibilities

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Title ______

Organization ______

Location (City, Country)______

Start Date ______

End Date ______

Total Time Period ______

Key Responsibilities

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Title ______

Organization ______

Location (City, Country) ______

Start Date ______

End Date ______

Total Time Period ______

Key Responsibilities

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Title ______

Organization ______

Location (City, Country)______

Start Date ______

End Date ______

Total Time Period ______

Key Responsibilities

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---- PLEASE ATTACH YOUR RESUME AT THE END OF THIS APPLICATION*----

ACADEMIC EXPERIENCE

Secondary or High School

Name of school * ______

Graduation Year * ______

Location (City/Country) * ______

Highest Academic Qualification

What is your highest academic qualification? *

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School/College/University * ______

Certificate/Degree/Diploma * ______

Area(s) of Study * ______

Graduation Year * ______

Location (City/Country) * ______

AWARDS & RECONGNITIONS

Please use this area to tell us about any significant awards or recognitions that you have received in the last 5 years (i.e., prizes, honors, other fellowships, etc.). It is fine to say “none”.

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REFERRAL SOURCE

How did you find out about this opportunity? *______

ESSAY QUESTIONS

Part 1

You have already explained your role and responsibilities above. What is your motivation to do this work now, at this stage in your life? (200 words max.)*

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What is your vision for the region you are applying from? How is your current role contributing to achieve that vision? (200 words max.)*

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Explain what development goals (personal and/or professional) you are working on currently and why you think you need to develop them? (300 words max.)*

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How will being an Acumen Fellow help you achieve these development goals? (300 words max.)*

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Part 2

Could you please list, what you consider to be major achievements (personal and/or professional) in your life in the last 3 years? Also tell us why you consider them achievements (200 words max.)*

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What was the greatest challenge you faced or failure you experienced? How did you overcome that challenge/failure? (200 words max.)*

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Do you consider yourself to be a successful individual today? If yes, tell us why. If no, tell us why not. (200 words max.)*

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Different people learn differently. Tell us how do you learn best? And tell us about a particular concept or idea you learned this way. (200 words max.)*

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REFERENCES

Please provide 2 professional references. These should be people who you have worked with before in a professional setting, and should not be a family member, spouse, or friend. Please note that your referees may be contacted at any point via the email addresses and/or phone numbers you provide.

Reference 1

Name* ______

Title* ______

Organization* ______

Email Address* ______

Phone Number * ______

How do you know this person? *

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Reference 2

Name* ______

Title * ______

Organization* ______

Email Address* ______

Phone Number* ______

How do you know this person?*

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YOUR CURRENT ADDRESS

Street Address ______

City * ______

State/Province ______

Country * ______

P.O Box/ZIP Code ______

TERMS AND CONDITIONS

Participants are expected to attend ALL program meetings (i.e., 4 seminars, 1 Learning Trip, and 1 Innovation Conference), which could include travel to different locations in India. All program-related expenses are provided by Acumen. Acumen and its partners are investing a significant amount of resources, effort, and time into this program, and we must ensure that all participants are committed to the program. Missing even one meeting merits expulsion from the program. If admitted, you must commit to attending ALL program meetings.

Participants are expected to complete ALL program assignments, participate in program activities and stay in communication with other Fellows in between seminars. Failure to complete assignments and lack of engagement/participation merits expulsion from the program. If admitted, you must commit to completing ALL program assignments/activities and staying in communication with other Fellows.

Your dedication to poverty alleviation is an instrumental criterion determining your selection in the Fellows Program. If selected, you must commit to continue working in a leadership capacity in poverty alleviation for the duration of the one-year program.

All finalists are expected to attend a Selection Conference in Mumbai on 26October 2013, which is a one-day final selection event. Participants are expected to cover their own expenses for travel to/from Mumbai, and accommodation in Mumbai. If selected, you must commit to attending the Selection Conference.

Note: Acumen wants to ensure that all shortlisted candidates are able to attend, regardless of their financial situation. As a result, in some special situations and upon request, Acumen will consider providing financial assistance to finalists who cannot cover these costs.

I hereby verify that the above information is true and correct to the best of my knowledge and belief. I affirm that the above responses and essays are original and not plagiarized. I understand that misrepresentation or plagiarism of any kind is grounds for immediate disqualification from the selection process.

Do you agree to the above Terms and Conditions? (check box )

I acknowledge that I have read and agree to the above Terms and Conditions.

THIS IS THE END OF THE APPLICATION.

-- PLEASE ATTACH YOUR RESUME AFTER THIS PAGE --

THANK YOU FOR APPLYING TO THE

INDIAFELLOWS PROGRAM!