NEF Ambassadors Application
Instructions: This application form has the following 6 sections which must be
completed in full.
Section 1: Provide contact information and basic bio-data.
Section 2: Provide a professional photo. Photograph (face and shoulders only &
must be high-resolution) **Please copy and paste photograph in the designated
spot and replace the placeholder cartoon picture.
Section 3: Prepare a two-minute video responding to the questions. The video
must not exceed 2 minutes. You must upload your video to YouTube and provide
the YouTube link in the application form. Please make the video public.
Section 4: Prepare answers to questions in no more than 250 words each.
Section 5: Provide your signature and consent.
Section 6: Provide your CV or resume.
Submission Instructions:
1. Make sure that your application form is in one file. You must submit it
as a PDF document. Applications that do not follow this naming convention
will not be accepted.
2. Rename this application form to CountryofCitizenship - Lastname,
Firstname Middlename.docx
3. Send the completed application form to [email protected]
Deadline for submission: 3 September 2017
Open to: Algeria, Angola, Burkina Faso, Burundi, Central African Republic,
Cape Verde, Comoros, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia,
Gabon, Guinea Bissau, Lesotho, Liberia, Libya, Madagascar, Mauritania,
Morocco, Mozambique, Namibia, Republic of Congo, Sao Tome and Principe,
Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan,
Swaziland, Tunisia, Zambia, Zimbabwe
NEF Ambassadors Application
Section 1: Contact Information and Bio-Data
Last Name: Click here to enter text.
First Name: Click here to enter text.
Middle Name: Click here to enter text.
Title:
Gender:
Mr ☐ Mrs ☐
Male ☐
Date of Birth:
Ms ☐
Dr. ☐
Other Title: Click here to add title.
Female ☐
DD/MM/YYYY
Nationality (Country of Citizenship): Click here to enter country name.
Country of Residence (In which country are you currently residing?): Click here to
enter country name.
Mailing Address: Click here to enter text.
City: Click here to enter text.
State/Province/County (N/A if not applicable): Click here to enter text.
Country: Click here to enter text.
Postal Code (N/A if not applicable): Click here to enter text.
Employment Status:
Student ☐
Professional ☐
Academic ☐
Name of organization or company affiliated to: Click here to enter text.
Email: Click here to enter text.
Phone Number (Include country extension): Click here to enter text.
SkypeID: Click here to enter text.
Section 2: Photo
Please copy and paste your photo here. Your photo will replace this placeholder
photo. You can right-click on the photo below and choose the option to “Change
Photo.” You will then select your own photo to place here.
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NEF Ambassadors Application
Section 3: Youtube Video Link
We want to get to know you better and to do this we would love to hear you speak
to us by video. The video does not have to be professionally done (it can be
taken with a camera or phone, for example), but the picture and sound should be
clear. Your video will be 2 minutes at the most.
In the video, please clearly:
a) Tell us why you want to be a NEF Ambassador?
b) What special skills and contributions would you bring to your role
as NEF Ambassador?
You can upload the video via YouTube. Please paste the link here:
Click here to enter text.
Section 4: Questions
Answer the following questions in no more than 250 words each in the space
provided:
1. What do I want to learn from and share at the NEF Global Gathering?
Click here to enter text.
2. What are at least three strategies I will use to share this knowledge
with at at least 20k people when I return to my community?
Click here to enter text.
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NEF Ambassadors Application
3. Please provide one to two online links that demonstrate an active
presence online. Describe the link(s) and its significance. How many
followers did you have and what strategies did you use to engage your
followers? (max 150 words – links can include Face-book, YouTube,
Twitter, blog, Instagram, and other mainstream so-cial media outlets).
First link: Click here to enter text.
Second link: Click here to enter text.
Section 5: Signature
By submitting this application, I agree that my name, photo, video and other
information may be used on the NEF promotional materials and social media
platforms and grant permission to AIMS and the Next Einstein Forum to use them.
I hereby certify that the information submitted on this form and in the attached
documents is true and accurate to the best of my knowledge.
Signature:
Please note that if you do not have an electronic signature, you can print,
sign and scan application form.
Date: DD/MM/YYYY
Section 6: CV or Resume
PLEASE INSERT YOUR CV HERE and check that you have labeled this file correctly
before submitting your application.
- End of Form -
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