2016 U.S. Department of State and Espnw Global Sports Mentoring Program

2016 U.S. Department of State and espnW Global Sports Mentoring Program

Application Checklist

Gender

Previous travel to the U.S.? If yes, please specify duration and type of visit Moroccan Citizen  Yes  No Number of Years of Work Experience

Current Employer

Level of Education (bachelors, masters, PhD, other)

In order for your application to be complete, please make sure you have:

 Completed application checklist form (this page)

 Completed application form (pages 2- 6 of this document)

 Copy of passport

 Most recent curriculum vitae

 One or two recommendation letter(s)

* Completed applications and required attachments must be received via e-mail by June 8, 2016. Any applications received after this time will not be considered. Please e-mail all applications and supporting documents to: [email protected]

of 6 U.S. Department of State and espnW Global Sports Mentoring Program

Application Form 2016

 Name: ______(First name) (Last name)

 City and Country of Birth:

 Date of Birth written in full: (Month) (Day) (Year)

 Passport no:

Date of issuance: ______(Month) (Day) (Year)

Date of expiration: ______(Month) (Day) (Year)

 Marital Status:

 Citizenship:

 Special considerations, such as allergies, medical and physical challenges, dietary preferences:

 Business address, telephone and fax numbers:

 E-mail address:

 Home address and telephone:

 Preferred Mailing Address: Business ( ) Home ( )

 Languages:

o Native Language:

o English Proficiency: . Speaking: . Comprehension: . Written:  Social Media: If available, please provide information on any social media tools that you may use. These include Twitter, Facebook personal account, Facebook organization account, or Page 2 of 6 other.

 Present Position: (exact title, starting date, and brief description of role in company/organization)

 Full Name of Company/Organization:

 Brief Description of Company/Institution: (Please Include information on the organization's sector (private, public, non-governmental), number of employees, annual budget, organization mission, relevance to the sports sphere, and website)

 Professional memberships in local, national or international professional organizations or associations or clubs:

 Previous travel to the United States: (Please note if applicant has ever traveled on a U.S. government program)

o Dates: o Places Visited: o Sponsorship/Purpose of Visit:

 Other Travel Abroad

o Dates: o City and Country: o Principal Purpose of Visit:

 Educational Background: (List highest degree first. Include significant training programs) Page 3 of 6 o Dates: o Degree/Certificate: o Institutions: o Field of Specialization:

 Other Interests and endeavors outside of work: (Hobbies, Volunteer Activities, etc.)

of 6 PERSONAL STATEMENT

Please answer all of the following questions in your personal statement: This can be more than one page, but it is important that all six questions are answered in the following order.

1- Why do you think you will be a good fit for this exchange program? 2- What do you hope to gain from the mentorship experience and how will you maximize the opportunity? 3- What are your personal, executive, and technical strengths? 4- What are your accomplishments and contributions to society, particularly in the context of sports and female empowerment? 5- What are your personal interests outside business? 6- How do you expect the program to impact your work when you return to Egypt?

of 6 RECOMMENDATION CONTACT

Identify one individual (or more) who can provide you a letter of recommendation (other than the one to be submitted with the application). Please have this/these recommendation(s) letter ready with you if you are called back for an interview.

Name Title Mailing Address Telephone Number Email Address