Catalyst Training Scholarship Application
Dear young woman leader (age 18-25),

We have space in Empowerment WORKS' Catalyst Action Training beginning April 18 - 21, 2017.

Summary: http://nepal.empowermentworks.org/cat/

If you wish to join this or be considered for a future program, please complete the form below.

NAME
first and last
Your answer
Telephone #
Your answer
Email Address
Your answer
Facebook profile link, and other social media/ linked in?
Your answer
Affiliated Organization, Your Role/ Position, and affiliated Website(s)
Your answer
Birthdate
MM
/
DD
/
YYYY
Are you available to attend the first 4 day training starting Tuesday April 18 through through Friday April 21st?
If not, please select other to be considered for a future date (note: future dates are more competitive)
Required
Why do you wish to be an Empowerment WORKS Catalyst? Tell us, what are you passionate about, and what change do you wish to create?
What do you aim to achieve through participation? (One or two sentences is ok!)
Your answer
What community service or economic enterprises have you participated in? What was/ is your role?
Your answer
Follow Up Collaboration?
The Catalyst Action Training (CAT) is a year long program based in KTM. Please select any/ all of the below will you be available for.
Required
Which of the following six Partners In Empowerment (PIE) Sectors do you most identify with?
Select the area that describes your daily role, or that you have the most skills to contribute in
Are you able to get to the training and back? (Venue: Maan Nam restaurant/ event center (Across street from Bhatbhateni Naxal) Please answer Yes, or briefly explain costs and what you can afford.
Your answer
Submit
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