Applications that exceed maximum limit of words will not be reviewed.

Application Form

Please print, type or word process.

Personal Information

Name
Nationality
Gender	Male	Female
Date of birth
Address
Telephone
Email, if applicable

Brief Biography [Maximum 110 words, must fit in the box]

Please briefly mention your work experience and academic formation, main accomplishments, and any awards/honors received.)

Community Service [Maximum 200 words, must fit in the box]

Please describe any community service activities that you are involved in. Specify any projects or programs that you are working on.

What do you hope to achieve through your participation at the Youth Summit?

[Maximum 100 words, must fit in the box]

Key Interest/Involvement

The Youth Summit will focus on the following key issues. Please rank (from 1 to 5) your involvement and/or interest in the following areas:

• Technology
• Education/Training
• Employment
• Health
• Community Service and Participation

Personally, how are you contributing to the social and economic progress of your country? What are the limitations/obstacles that you face in doing so as a young person? How do you think young people can contribute to society and how do you think enhancing youth participation will benefit your country/region? Please cite two main recommendations in terms of policies, interventions, programs, or partnerships to enhance youth participation. Please describe how information technology has helped you meet your social or economic development objectives or explain what role you see technology playing in helping you to meet your development objectives?

Please list two persons, not related to you, who are familiar with your work/academic formation, community involvement, and personal characteristics.

Name	:
Title and Organization	:
Address	:
Telephone	:
Email, if applicable	:

Name	:
Title and Organization	:
Address	:
Telephone	:
Email, if applicable	: