25-31 July, 2015.

Moscow, Russia
russia.pglf.org

APPLICATION FORM
A completed registration form (see below) is necessary to register and be considered for participation in the
Preparing Global Leader Summit (PGLS). Please, fill the form out in English, including the titles and names
of the programs you have completed/participated in. A confirmation letter will be sent to the applicant by
e-mail upon the acceptance of your application. Please note that incomplete applications will not be
accepted. The PGLS can grant refunds should an admitted applicant decide against participation due to the
unforeseen circumstances. However, refunds will only be granted if a cancellation and refund request are
received by July 10, 2015. Should you need more information, do not hesitate to contact the program
administration board via e-mail at PGLS@PGLF.org.

Application type:
Category A

Category B

*Category A: applicants who hold a citizenship of a country that needs VISA to enter Russia.
*Category B: applicants who hold a citizenship of a country that does not need VISA to enter Russia.

(Please type)

PERSONAL DATA
Family Name:
First Name:
Gender:

1.

Date of Birth:
Country of Birth:
M/F

Country of Citizenship:

ADDRESSES (Please fill in completely)

a. Home Address

Home Address:
Home Address 2:
City / State

Line1
Line2

Zip code:
Phone:
Email:

MM.DD.YYYY

b. Work address (if applicable)

Work Address:
Work Address 2:

Line1
Line2

City / State

2.

Zip code:
Phone:
Email:

ACADEMIC / PROFESSIONAL INFORMATION (please list only the most

relevant academic / professional experience starting with the most recent one; upload your CV in .pdf format
for further information)

University / Institution:
Year of Study and Course:
Start date:
Graduation Date (if applicable):
Country:
Have you previously attended another
University:
If yes please list:

Yes:

No:

University Name
Course:
Dates Attended:
(*copy/paste section 3. should you wish to add more information)

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Yes:

3.1. Have you applied to PGLS before?

No:

*If yes please specify which year:

2.2. Have you already attended other leadership

schools of the Preparing Global Leadership
Foundation? (e.g. PGLI, PGLA, GLP etc.)

Yes:

2.3. Have you attended any other conferences,

forums, summer schools, or other
academic events?

Yes:

3.

No:

*If yes please specify which leadership school:

No:

*If yes please list the events, starting with

the most recent ones:

ENGLISH LEVEL COMPETENCE (please note that PGLS is taught entirely in

English. Therefore, a satisfactory competence in the English language is essential for the successful
completion of the program)

Please state your level of knowledge of English language

Basic

Intermediate

Advanced

Mother tongue

PASSPORT INFORMATION
PLEASE NOTE: The following Passport Information is required for all applicants who have a valid passport. Please
make sure that your passport will not expire before the end of the Summit to which you are applying. If you are in
the process of applying for or renewing your passport, leave this section blank and email to PGLS@PGLF.org (with
the subject line PASSPORT INFORMATION) the following information when the new passport becomes available.

Do you have a valid passport?

Yes:

No:

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Country Issuing Passport:

Passport Number:
Passport Issuance Date:
Passport Expiration Date:
Full name (must be written as it appears on your
passport):
Do you have special physical or medical needs?
If yes, please, specify

Yes:

No:

Please, provide the following details of someone

we can contact in case of emergency while you are
at PGLS
First name, Last name
Phone number
E-mail address

MOTIVATION
Briefly indicate the motivation for participation at Preparing Global Leaders Summit and what
you would like to gain by attending it. Please also identify a pressing problem in your country and
elaborate on how you aspire to overcome it as a future leader (max. 300 words):

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How did you find out about this program?

Name the source (institution, person, internet resource)

PROGRAM COST AND SCHOLARSHIPS

The program cost is $1200 (USD).
Tuition, study materials, housing, daily breakfast and lunch, two formal dinners, and visa support
(invitation letter) is included in the cost of the program. Participants are expected to fund their
travel and visa costs on their own.
A limited number of partial scholarships for the cost of the program are offered on a competitive
basis. Should you wish to apply for a scholarship, please refer to Section 9. If not, please check
the box below:

Self-financed participation

SCHOLARSHIP APPLICATION
Instructions: This section applies to all participants who wish to apply for a scholarship. Scholarships
are awarded based on a combination of financial need and merit. Awards are made on a rolling basis in
conjunction with admission to the program, with earlier applicants receiving priority consideration.
Students are responsible for finding additional sources to cover the full tuition in case partial scholarships
have been awarded. Please note that upon admission to the program, PGLS is going to supply you with
a support letter you can forward to potential sponsors (local NGOs, public institutions, political parties,
embassies and consular representations, international funds etc.).
Would you like to apply for scholarship funding?

Yes:

No:

Scholarship Statement
Please write a brief statement describing your need for a scholarship (max. 200 words):
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The priority application deadline is June 1, 2015. Applicants in need of scholarship

support are urged to apply before the priority deadline. While scholarship support is
available after the early deadline, it is allocated on a rolling basis and earlier applications
are given priority. Final deadline for Category A applicants is June 15, 2015. Category B
applicants may apply until June 30, 2015.
After you have completed your application please email your CV (resume) in .pdf format and any
other relevant documents (language test scores, dietary restrictions, etc.) to PGLS@PGLF.org.

Preparing Global Leaders Summit: Vernadskogo pr. 82, Moscow, Russia. www.preparinggloballeaders.com

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