2019 APPLICATION: Alliance for Science Global Leadership Fellows Program
2019 Application Period: JANUARY 15 - MARCH 1

NOTE! You are UNABLE TO SAVE DRAFTS in this online application form. We recommend you develop and save your short essay responses in a separate document, then copy and paste your responses here when they are complete. Additionally, a video response (with written transcription) is required for one of the questions. You will need to record, upload, and transcribe your response in advance of submitting this application. Thank you!

First Name (as it appears on official documents) *
Your answer
Middle Name (as it appears on official documents)
Your answer
Last Name (Surname) as it appears on official documents *
Your answer
Your Preferred Name (as you like to be called)
Your answer
Profession *
Your answer
Country *
Your answer
Mailing Address *
Your answer
Date of Birth *
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Gender *
Primary Email Address (Please be sure to enter correctly; this is how we will contact you.) *
Your answer
Secondary Email Address (if applicable)
Your answer
Mobile Phone Number with Country Code *
Your answer
Highest Level of Education Attained *
Social Media Presence (e.g., Twitter handle, Facebook, LinkedIn, etc.)
Your answer
SHORT ESSAY
Please answer ALL the questions below. NOTE: A video recording and written transcription are required for one of the final questions. Please prepare in advance. Follow instructions associated with questions. (Please recall you cannot save drafts in this online form.)
In 200 words or less, please tell us your story and why the 12-week Alliance for Science Global Leadership Fellows Program is your next chapter. *
Your answer
Name 2-3 networks you are actively involved in and describe your participation and how you use them. Please describe the potential of these networks for organizing and mobilizing for campaign impact. *
Your answer
What are your 2-3 preferred communication channels and why do you think they are effective for your intended communication purposes (e.g., radio, print media, YouTube, Twitter, Facebook, other social media, other channel)? *
Your answer
Describe a strategic campaign or activity that you would like to carry out after the 12-week training to address a food security challenge in your country. Assume you only have your time and your networks as resources. *
Your answer
What challenges, if any, would you have to overcome to participate in the 12-week training in Ithaca, New York, USA (e.g., work, family)? *
Your answer
Have you attended an Alliance for Science short course? If so, please indicate the name, location, and date of the course. *
Your answer
How did you learn about this training opportunity? Were you nominated or referred? If yes, please note your nominator. *
Your answer
VIDEO: PERSONAL STATEMENT
Please provide a ONE-MINUTE MAXIMUM video response to the question below. A written transcription of your recording is also required so we may refer to it with your recording.

RECORDING INSTRUCTIONS: Please record an unedited video response that does not exceed one minute in length. For recording, find a quiet space for clear audio; make sure the camera is stable; and ensure the lighting is appropriate for good visibility. Upload your one-minute recording to YouTube and provide the URL link below. You will want to set your privacy settings to "UNLISTED" for this video. (Instructions for uploading a video to YouTube are found here: https://goo.gl/41sfKw) THANK YOU!

QUESTION: Why do you want to be a part of the Cornell Alliance for Science Global Leadership Program and what would be your unique contribution?
Please provide the YouTube URL link to your video here. *
Your answer
Please provide a written transcription of your one-minute video here, so we may refer to it with your recording. *
Your answer
LOGISTICS
Please answer all logistical questions below to the best of your ability.
Do you have any dietary, medical, or other conditions we should know about? If so, please explain. *
Your answer
Do you have a valid passport that remains valid for the next 12 months? (Note: Answering "no" does not count against your application. Please be aware that if you are admitted to the program, a valid passport of at least a year's length will be required to obtain a travel visa.) *
CO-FUNDING
We ask program participants to seek organizational co-funding opportunities that could support program costs. Program expenses may be divided into the following tangible categories:

- Visa fees
- Round trip travel (i.e., flight costs) – Depends on location of participant
- Housing (i.e., rent and utilities) – Approximately $3,500 USD
- Living stipend – Approximately $4,500 USD
- Course fees – Approximately $8,000 USD
- Health insurance coverage – Approximately $1,000 USD
- Library fee – $1000 USD

Please list sources of support you have, pending or secured, that may help fund your program participation. (For example, the project team you work on may have funds for professional development.) We encourage you to seek organizational co-funding rather than personal financing. *
Your answer
MEDIA RELEASE: Participants of the Global Leadership Fellows Program are included in media imagery that is developed during the program. If you become a Fellow of this program, do you grant permission to the Cornell Alliance for Science to record and use any images of you (including, but not limited to visual imagery, vocal, still photographs, print, computer, or web-based graphics) in all media, in global distribution, and in perpetuity? *
THANK YOU FOR APPLYING!
Our application period closes March 1, 2019. Our review period will run into mid-April 2019. Thank you for your patience during this process.
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