2017 JCI Mauritius TOYP Application Form

The JCI Mauritius Outstanding Young Person Award (TOYP) serves to formally recognize young people who excel in their chosen fields and create positive change. By recognizing these young people, JCI raises the status of socially responsible leaders in this world. The honorees motivate their peers to seek excellence and serve others. Their stories of discovery, determination and ingenuity inspire young people to be better leaders and create better societies.

All fields are required and must be filled in English. Applications will not be accepted after the deadline which is 23 April 2017 at midnight.

Eligibility

1) Nominees must be between the ages of 18 and 40. Nominees born before January 1, 1977 or after December 31, 1998 are not eligible for JCI TOYP. A copy of the National ID Card or Birth Certificate should be enclosed along with the application form.

2) The nominee should be a citizen of the Republic of Mauritius

3) The nominee must be a resident of the Republic of Mauritius and be present in Mauritius during the judging process and for the Awards ceremony.

4) The nominee should not be a current member of the JCI Mauritius board at the International, National or Local level.

5) The nominee/ nominator must attest to all facts contained in the form and grant permission for publication of these facts. The nominee may be required to attend the JCI TOYP Awards Ceremony in Amsterdam, Netherlands, if selected as a 2017 Honoree.

6) All information must be contained on the application form. Video clips, Scrapbooks, audiotapes, etc. are not used in the judging process. However, if a candidate is selected as one of the ten international honorees, these items will be requested by JCI World Headquarters.

Application Documents

 A good quality, 4" x 6" (10 cm x 15 cm) black-and-white, head-and-shoulders photograph must be submitted along with the official nomination form. This file must be in JPG Format and cannot be greater than 2MB of size.

 National Identity Card or Birth Certificate: A copy of the ID/Birth Certificate should be attached along with the nomination form This file must be in JPG Format and cannot be greater than 2MB of size.

 Application Form: Application form must be signed by Nominee and Nominator Unsigned application form will be rejected. PART 1 - NOMINATION FORM Please Select Category:

□ Business, economic, and/or entrepreneurial accomplishment □ Political, legal, and/or governmental affairs □ Academic leadership and/or accomplishment □ Cultural achievement □ Moral and/or environmental leadership □ Contribution to children, world peace, and/or human rights □ Humanitarian and/or voluntary leadership □ Scientific and/or technological development □ Personal improvement and/or accomplishment □ Medical innovation

Part 1A. Personal & Business Information (To be filled by nominee)

(*) Required Field NOMINEE’S FIRST NAME:* (as it appears in I.D.)

NOMINEE’S SECOND NAME:* (as it appears in I.D.)

TITLE:* (Dr./Mr./Mrs./Ms./PHD,etc.)

NAME TO APPEAR ON THE TROPHY:*

(your name and any professional title (such as Doctor) EXACTLY as you wish it to appear on your trophy, in the video, and any other material produced for the 2017 TOYP Program in case the you will be selected as one of the honorees.)

BIRTHDATE (DD/MM/YYYY):*

HOME ADDRESS:*

EMAIL ADDRESS:*

HOME TELEPHONE:* MOBILE NUMBER:*

OCCUPATION OR PROFESSION:* BUSINESS NAME (IF APPLICABLE):

BUSINESS ADDRESS (IF APPLICABLE):

BUSINESS TELEPHONE:

EMAIL ADDRESS:

EDUCATION (DEGREES, ACADEMIC HONORS, ETC.):*

CIVIC, FRATERNAL, ORGANIZATIONS AND AFFILIATIONS:

PUBLISHED WORKS: Part 1B. Nominee’s Career information (to be filled by nominee) (*) Required Field

Outline the career of the nominee, including background on the nominee’s work or field of activity.* (Word limit is 200 words)

Provide information which will help the judges understand the challenges, problems, and scope of the nominee’s area of activity. * (Word limit is 300 words)

Describe the nominee’s exceptional achievements or contributions in his/her chosen field * (Word limit is 200 words)

List public statements from authorities, honors, and awards received which affirm the nominee’s achievements or contributions. * (Word limit is 100 words)

Part 1C. To be filled by Nominator**

(*) Required Field

Summarize the nominee’s most outstanding efforts that exemplify the principle expressed in the following line of the JCI Creed: “That service to humanity is the best work of life.” * (Word limit is 400 words)

Summarize within this space why you believe that the nominee should be selected as one of Ten Outstanding Young Persons of the World for 2017* (Word limit is 200 words)

Nominator**

 A nominator is a referee, someone who can bear testimony to your achievements (or one specific), other than yourself, it may be a member of your entourage or your family.  A nominator can also be a well-established public figure or respected/renowned professional in his/her domain. It can be a superior or a co-worker.  Alternatively a nominator maybe a member of JCI.

Part 2. DECLARATION

The Following section should be completed by the Nominee

I attest to all facts contained in my nomination form and give permission for the facts to be used for publication. In agreeing to accept a JCI TOYP Award, I understand that, barring extreme circumstances, I am required to be present from November 6, 2017 to November 10, 2017, for the JCI TOYP Ceremony and activities at the 2017 JCI World Congress in Amsterdam, Netherlands. In the event that circumstances prevent my attendance, I must present the conditions to the President of JCI for a decision on the continued eligibility of my nomination. Signature of Nominee: …………………………………….………… Date: ……..………………

Name of Nominee: ………………………………………………………………………………..

The Following Section must be completed by the Nominator

Name of Nominator: ………………………………………………………………………………..

Telephone: …………………..…….. Email: ……………...………………………………………………..

Occupation/ Profession: ………………………………………………………………………………..

If JCI Member, Name: ……………………………………………… Chapter: ……………..…….

Signature of Nominator: …………………………………….………… Date: ……..………………

Name of Nominator: ………………………………………………………………………………..

FOR OFFICE USE

Name of National Organisation:

Signature of 2017 TOYP Project Director: Date:

Signature of 2017 JCI Mauritius National President: Date: