EAST AFRICA FELLOWS PROGRAM APPLICATION FORM FOR THE ACUMEN EAST AFRICA FELLOWS PROGRAM CLASS OF 2016 INSTRUCTIONS: All applications must be received by 10:00 AM GMT (Greenwich Mean Time) / 1:00 PM EAT (East Africa Time) on 31st July 2015. Late or incomplete submissions will not be considered. Before beginning the applications, please review the "Application Instructions" section of our website for eligibility criteria and application instructions. 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 FAQs, you may email [email protected] Application Instructions: http://acumen.org/content/uploads/2015/05/RFP-2015-Application-Instructions-FINAL.pdf FAQs: http://acumen.org/content/uploads/2015/05/Regional-Fellows-FAQs-2015-FINAL.pdf 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 + Please submit your resume/CV along with this application form Please complete this application in English. Fields marked with an * are required. You will not be able to exceed the character limits. It is strongly recommended that you compose your essays in a word processor with a character count feature. Next steps after submission of application: Update to all applicants – Early September 2015 Phone interviews – September 2015 Selection Conference (in-person interviews) – 24th October 2015 Final Selection of 20 Fellows – November 2015 First Seminar – February/March 2016 If you would like submit a paper application, please print out this form, fill it in and mail it to us by Monday 27th July 2015. Please send it to the following address: Acumen East Africa 1st Floor, Cape Office Park, opposite Yaya Centre Ring Road, Kilimani P.O. Box 101883-00101 Jamia Nairobi, KENYA Phone: + 254 716 252802 / +254 736 073036 1 EAST AFRICA FELLOWS PROGRAM Background Information Contact Information First Name* ___________________________________________________________ Last Name* ___________________________________________________________ Email Address* ___________________________________________________________ Primary Phone* ___________________________________________________________ Secondary Phone: ___________________________________________________________ Is this your first time applying for the Acumen Fellows program? * Yes / No If 'no', please specify which fellows program you applied for and when _________________________________________________________________________________ Personal Information Fellows must demonstrate a long-term commitment and concrete connection to East Africa. What is your nationality?* ____________________________________________________ What is your country of residence?* ___________________________________________ What is your gender?* (Circle one) Male / Female / Other What is your date of birth?* (DD/MM/YYYY) ___________________________________ 2 EAST AFRICA FELLOWS PROGRAM Social Change Work We are looking for individuals who are not just dreamers, but doers. Each selected Fellow must demonstrate 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. We will consider a handful of exceptional individuals who are not currently engaged in a project, but have significant experience or show strong leadership potential. (Note: If you are involved in multiple projects that create social impact, describe the project that takes most of your time. If you are not currently engaged in a project, describe the project that you were most recently working on.) What is the name of your social change organization/project?* _____________________________________________________________________________ In one or two words, what is your organization’s/project’s main area of focus? _____________________________________________________________________________ What is your title at this organization/project? _____________________________________________________________________________ For how long have you been working at this organization/project? _____________________________________________________________________________ What is your time commitment at this organization/project? (Note: Full-time is 40 hours/week or more, Part-time is less than 40 hours/week) _____________________________________________________________________________ 3 EAST AFRICA FELLOWS PROGRAM Work Experience Total number years of work experience* ___________________________________ What is your main area of expertise?* ___________________________________ Education Secondary or High School Name of school/institution _______________________________________________ Graduation year _______________________________________________ Location (City, Country) _______________________________________________ Highest Academic Qualification What is your highest academic qualification? Circle one: Primary School Secondary School (“O” or “A” Levels) Vocational/Technical School (Associate’s Degree) Undergraduate (Bachelor’s Degree) Graduate (Master’s Degree) Doctorate (e.g., PhD, JD, MD) Area(s) of Study _______________________________________________ Graduation year _______________________________________________ Location (City, Country) _______________________________________________ Awards & Recognition Please use this area to tell us about any significant awards or recognitions that you have received in the last 5 years (e.g., prizes, honors, fellowships) _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 4 EAST AFRICA FELLOWS PROGRAM Information Source How did you find out about the Acumen East Africa Fellows program? (Please be specific and give names where applicable.) _____________________________________________________________________________ _____________________________________________________________________________ Referees Kindly provide the contact information of two professional referees. Your references should be people with whom you've worked closely, preferably line managers, co- founders, project supervisors/funders where applicable. They should not be family, friends or spouses. Name of Referee* _________________________________________________________ Relationship to you* _________________________________________________________ His/Her Primary Phone* _________________________________________________________ His/Her Email Address * _________________________________________________________ Name of Referee* _________________________________________________________ Relationship to you* _________________________________________________________ His/Her Primary Phone* _________________________________________________________ His/Her Email Address * _________________________________________________________ 5 EAST AFRICA FELLOWS PROGRAM Essay Questions Please answer the essay questions as directly and concisely as possible. You will not be able to exceed the specified word limits. It is strongly recommended that you compose your essays in a word processor with a word count feature. Be authentic. Don’t just write what you think we want to hear. Use stories to show, rather than tell us about yourself. For example, don’t just say you are a very curious person; tell us a story that illustrates this trait. Use the essay portion of the application to tell us more about yourself from a personal perspective and share more about your social change project. We already know about your skills and experience from your background information and resume – now we want to get to know you on a deeper level. 1. Where does your passion and motivation for social change work come from?* (200 words) We have your resume, so focus more on the personal and less on the professional. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 6 EAST AFRICA FELLOWS PROGRAM _____________________________________________________________________________ _____________________________________________________________________________