DELEGATEAPPLICATION

To be completed by the applicant. Applicants must submit this form along with all other Application Documents in an email to info@girls20.org.
Save this document as follows, using the applicant's information 2016Application_Country_FirstNameLastName

PERSONALINFORMATION
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First Name

Last Name

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Middle Name

Email Address

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Twitter Handle

Facebook Account

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Instagram Handle

LinkedIn

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Phone Number (including area code)

Date of Birth (MM/DD/YY)

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City and Country of Residence (City, Country)

Country of Citizenship

____________________________________________________________________________________
Departure Airport (City, Country)

Studying abroad? Yes:

No:

Return Airport (City, Country)

If yes, School:_________________Country: _______________________

GUARDIANINFORMATION
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Guardian Name

Relationship to Applicant

____________________________________________________________________________________
Guardian Phone Number (including area code)

Guardian Email Address

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PASSPORT DETAILS
*if you do not yet have a passport, you will be required to provide this information by APRIL 31th, 2016
if you are chosen as the delegate from your country.

Do you have a valid passport?

Yes:

Not Yet:

____________________________________________________________________________________
Name as it appears on passport

____________________________________________________________________________________
Date of Issue (MM/DD/YY)

Place of Issue

____________________________________________________________________________________
Passport Number

Expiry Date (MM/DD/YY)

FAMILY INFORMTATION

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Mothers profession

____________________________________________________________________________________
Fathers profession

Do you have siblings?

Yes:

No:

Are you the 1st person in your IMMEDIATE family to go to post-secondary school?
Yes:

No:

Please list who in your family has gone to post-secondary school:

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ALL 11 QUESTIONS MUST BE ANSWERED TO BE CONSIDERED COMPLETE.

*Incomplete applications will not be considered

QUESTION 1 of 11: What do you believe is the greatest obstacle for girls and women in your
country and why? (Max. 250 words)

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QUESTION 2 of 11: Describe the leadership roles you have taken in your school or in your
community. Please provide the position you held, the dates and the impact you had.
(200 words max. for each position )

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QUESTION 3 of 11: If you could offer one idea to G20 Leaders around increasing female labor
force participation, what would that idea be?
(Max. 500 words)

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QUESTION 4 of 11: How do you think this Summit will impact your life/career path?
(Max. 250 words)

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QUESTION 5 of 11: What do you want to be known for? (Max. 250 words)

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QUESTION 6 of 11: Why would you be the best candidate to represent your country at the
G(irls)20 Summit 2016?
(Max. 250 words)

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QUESTION 7 of 11: What would you do if you werent afraid?

(Max. 100 words)

QUESTION 8 of 11: Describe yourself in tweet form (Max. 140 characters)

QUESTION 9 of 11: Have you attended any other international conferences? If yes, provide the
name of the conference, location and date.

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QUESTION 10 of 11: After the Summit you will be required to launch a program/initiative to
help empower girls and women in your country. Please describe an initiative you will design and
deliver, with assistance from G(irls)20 and our partners. For examples of the initiatives that
have been launched by previous delegates, visit: http://www.girls20.org/programs/girls20summit/girls20-delegate-initiatives/

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QUESTION 11 of 11: Please record and submit a video, answering the following question.

What does empowerment mean to you?

Video Link:

If you cannot provide a video, please send a response in writing.

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