Hurford Youth Fellows Program

- Building Young Activists Leadership Skills -

SeptemberNovember 2012 and JanuaryMarch 2013 Fellowships

APPLICANT FORM
APPLICATION CHECKLIST

To Be Submitted by the Applicant via email to youthfellows@ned.org:

I.

Applicant Form

II. Rsum or Curriculum Vitae

To Be Submitted by Referees via email to youthfellows@ned.org:

III. Two letters of recommendation, sent directly to the program by the individual referees

APPLICATION DEADLINE: APRIL 30, 2012 Please refer to the Information Booklet and Application Guidelines for instructions on completing your application.

Hurford Youth Fellowship APPLICANT FORM

Part 1: Personal Information
I. Applicant Data (Please type or print clearly in English on the lines provided): Dr./Mr./Ms./Prof. Citizenship Current Job Title Work Address City Home Address City State/Country State/Country First/Given Name Middle Name FAMILY NAME/SURNAME Gender Institution Suite No. Zip/Postal code Apt. No. Zip/Postal code Office Phone Email

Date of Birth (month/day/year) Department

Home Phone (including country and city codes) Cellular/Mobile Phone Preferred Mailing Address: Fellowship Session :

Home

Work

September 15, 2012November 30, 2012 January 15, 2013March 31, 2013 Available for Either Session

A working knowledge of English is a prerequisite for participation in the program. Please indicate your level of fluency in English (excellent, good, fair, or poor) for each of the following: Speaking: Reading: Writing:

Native Language:

Are your fluent in any additional languages?

Do you or any organization you have been affiliated with receive funding from the NED or its core institutes (NDI, IRI, CIPE, and Solidarity Center)? An affiliation with organizations receiving NED support does not negatively affect fellowship opportunities.

Yes
Name of organization and date(s) of grant(s)

No

Have you participated in an exchange program in the United States on a J-1 visa in the past two years, and if so, when?

Yes No

Dates:

Category: (for e.g., J-1 Research Scholar, Specialist)

Please list any other fellowship programs to which you have or are currently applying for the coming year:

Hurford Youth Fellowship APPLICANT FORM

Part 2: Proposal
II. Project Proposal: A main component of the Hurford Youth Fellowship is to organize and conduct a series of online discussions with participants from around the world, as well as compile topic-related materials. These discussions will be based on a theme and topics that the fellow would choose. Please see the Information Booklet and Application Guidelines available at www.wymdonline.org for detailed information on the fellowship. Below, please describe the broad theme for your discussions. Additionally, based on this theme, highlight 3 specific topics that you can use for online discussions, and your methods for developing discussion materials as well as your plan for future involvement in the World Youth Movement for Democracy. In your proposal, please ensure that you respond to the following questions: 1. What is your proposed theme for the online discussion series? 2. What are three specific discussion topics or questions under your theme? 3. How would you conduct research and develop information materials that could be used for the online discussion? 4. How would you contribute to the further development of the World Youth Movement for Democracy? 5. How would you plan to benefit from your time in Washington for your professional development as well as your organizations work? (Word limit: 800 words)

Hurford Youth Fellowship APPLICANT FORM

Part 3: Curriculum Vitae & Biography
III. Rsum or Curriculum Vitae: Please attach a current rsum or curriculum vitae in a separate document. Biography: In the space below, please provide a brief autobiography (200 words or less). Be sure to include your current position, recent professional affiliations, and any noteworthy accomplishments.

Hurford Youth Fellowship APPLICANT FORM

Part 4: Letters of Recommendation
IV. Letters of Recommendation: Two letters of recommendation are required of all applicants. Letters should be type-written and in English (or accompanied by an English translation). For referee instructions, please refer to the Information Booklet and Application Guidelines. Please list the names, institutional affiliations, and email addresses of those writing recommendation letters for you: First Referees Name Second Referees Name Institutional Affiliation/Title Institutional Affiliation/Title Email Address Email Address

I certify that the statements made in this application are true and complete to the best of my knowledge, that I am not delinquent in repaying any U.S. federal debt, and that I will not engage in the unlawful manufacture, distribution, possession, or use of a controlled substance while conducting any fellowship activity. If awarded a Hurford Youth Fellowship, I certify that I will abide by the rules and policies of the fellowship program, including maintaining valid legal status, fulfilling tax and visa obligations, and meeting Hurford Youth Fellowship project requirements.

Name of Applicant

Date