East Africa Fellows Program

APPLICATION FORM FOR THE EAST AFRICA FELLOWS PROGRAM

Welcome to the online application for the East Africa 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 by 5:00 PM GMT (Greenwich Mean Time) / 8:00 PM EAT (East-Africa time) on 23rd September 2013. Late or incomplete submissions will not be considered. If you have questions or if you are having technical difficulties, please read the Frequently Asked Questions - if you still have questions after reading the FAQ, you may email [email protected].

The application for the East Africa 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 strongly recommended that you compose your essays in a word processor with a character count feature.

Submit this application in one of the following ways:  Via Email: [email protected]  Via Mail: Acumen East Africa Office 1st Floor, Cape Office Park, Opposite Yaya Centre Ring Road, Kilimani, P.O. Box 101883-00101 Jamia, Nairobi, Kenya

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) – 2 November 2013  Final Selection of 20 Fellows – November/December 2013  First Seminar – January/February 2014 EAST AFRICA FELLOWS PROGRAM

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 East Africa.

What is your nationality? * ______

Please indicate the total (cumulative) amount of time that you have spent in each of the following countries.

Kenya * ______

Rwanda * ______

South Sudan * ______

Tanzania * ______

Uganda * ______

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? * EAST AFRICA FELLOWS PROGRAM

______

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

______

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

______

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

______

What is your title at this organization? *

______

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*

______

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*

______

______EAST AFRICA FELLOWS PROGRAM

______

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

______

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:

______

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. Include at least one, and up to four impact numbers.

Example: Impact Number - 1000 Impact Description - Number of youth who have completed our 12-month entrepreneurship program.

Impact Number: ______

Impact Description: ______

______

Impact Number: ______EAST AFRICA FELLOWS PROGRAM

______

WORK EXPERIENCE

Total number of years of work experience *______

What is your main area of expertise? * ______

Work History*

Please fill out the below fields for no more than four relevant 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

______

Title ______

Organization ______

Start Date ______

End Date ______

______

Title ______

Organization ______

Start Date ______

End Date ______

______

Title ______

Organization ______

Start Date ______

End Date ______

______

---- PLEASE ATTACH YOUR RESUME AT THE END OF THIS APPLICATION*---- EAST AFRICA FELLOWS PROGRAM

ACADEMIC EXPERIENCE

Secondary or High School

Name of school * ______

Graduation Year * ______

Location (City/Country) * ______

Highest Academic Qualification

What is your highest academic qualification? *

______

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”.

______

REFERRAL SOURCE

How did you find out about this opportunity? * ______EAST AFRICA FELLOWS PROGRAM

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.) *

______

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

______

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.) *

______

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

______

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.) *

______

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

______

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

______

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.) *

______

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? *

______

Reference 2

Name * ______

Title * ______

Organization * ______

Email Address * ______

Phone Number * ______

How do you know this person? *

______

YOUR CURRENT ADDRESS EAST AFRICA FELLOWS PROGRAM

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 East Africa. 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 Nairobi on 2 November 2013, which is a one-day final selection event. Participants are expected to cover their own expenses for travel to/from Nairobi, and accommodation in Nairobi. 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 -- EAST AFRICA FELLOWS PROGRAM

THANK YOU FOR APPLYING TO THE EAST AFRICA FELLOWS PROGRAM