For CEOs, Directors, Civic Servants, Government Officials in Imo State

TELL US ABOUT YOUR ORGANIZATION

What is your role in the organization?EmployeeVolunteerSelf EmployedHead of OrganizationBoard Member

What is your level of responsibilityEntry LevelMiddleSenior

Is your organization endorsing your application to THE JPI LEADERSHIP BOOTCAMP?YesNo

Identify the priority populations your organization works with?ChildrenCommunities at LargeEthnic, Racial or Religious MinoritiesFarmersGovernment: Politicians or Civil ServicePeople With DisabilitiesRefugees & Displaced PersonsSenior Citizens / EldersWomenYouth/StudentsEntrepreneursWorkers - Formal SectorWorkers - Informal SectorOther

Identify the priority sectors your organization works inAdult EducationAgricultureAsset-based DevelopmentBusiness / Employment / EntrepreneurshipCapacity Building of Civil SocietyClimate ChangeCommunity Economic DevelopmentEducation / SchoolingEnvironmental SustainabilityFood SecurityGender/Women's RightsGood GovernanceHealth and WellnessHuman RightsLivelihoods and MarketsPeace Building & Conflict ResolutionUrban DevelopmentOther

EDUCATIONAL BACKGROUND

PROFESSION

Do you have leadership experience?YesNo

Do you have a Leadership role model?YesNo



Do you think of yourself as a Leader?YesNo

KNOWLEDGE OF..

How did you hear about the JPI Leaership Conference?FacebookTwitterSomeone from my OrganizationTeacher or MentorWebsite

FINANCES

The cost of the program is valued at ……………………. Candidates selected for the program will receive a full training which includes accommodation. The cost of the program as well as personal expenses while in program are the responsibility of the candidate.

REFERENCES

Each applicant is required to submit the names and contacts of at least two references. One of these references should be a supervisor / senior staff person from the applicant’s organization. Please check with your references and verify their email addresses; incorrect email addresses could delay your application.

FINAL NOTES

Sharing of Information (Please acknowledge below that you understand our need to provide this information and that you consent to its provision. I have read and understand the above statement and agree to allow JPI staff to share needed and relevant information)

Do you acknowledge?YesNo

Freedom of Information and Protection of Privacy (I hereby agree to abide by all the rules and regulations which apply to leadership bootcamp, by completing this Application, you indicate your consent, pursuant to the Freedom of Information and Protection of Privacy Act, to the collection, use and disclosure of your personal information as described above. I have read and understand the above statement and agree to the terms presented in the statement)

Do you agree?YesNo

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