PLO AFRICA MENTORSHIP PROGRAMME

(PLO AMP)
ONLINE REGISTRATION FORM
Thank you for expressing your interest to join our programme. By filling this form, we will know
you better. (Fill the form in TYPED BLOCK LETTERS and submit to info@plofoundation.org
The information provided in this form is private and confidential and will not be disclosed to any
third party.
PART A: Bio Data
Full Name:
ID/Passport/Birth Certificate No.:

Date of Birth: Date Month Year Age

Place of Birth:

Country: County or City

Gender: (Male) (Female)

Religion:
Postal Address:
Physical Address:
Phone (Landline):
Phone (Mobile):
E-mail Address:
PART B: Next of Kin
Name:
Relation to You:
Postal Address:
Physical Address:
Phone (Landline):
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PART C: Education Background

PART D: Professional Background (If Applicable)

PART E: About You

1. Tell us your three hobbies

2. Share with us your key strengths: -

a) As assessed by yourself

b) As assessed by people who know you well

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3. Share with us your weaknesses:
a) As assessed by yourself

b) As assessed by people who know you well

4. Share with us three songs you like listening to

5. Share with us three movies you like

6. Which three books do you like reading? (Kindly, write the title of each and the name of the
author.

7. What do you know about PLO Lumumba?

8. a) Have you ever heard about Pan-Africanism? (Yes) (No)

b) If yes, tell us what you know about it.

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9. Have you ever taken part in mentorship programme before? (Yes) . (No)

10. Where have you volunteered previously?

11. Share with us the reason (s) why you want to join PLO Africa Mentorship Programme.

12. What are you currently doing to help your society?

13. What are top five things that you want to accomplish in the next Ten (10) years?

14. Share with us your: -

a) Personal Vision

b) Personal Mission

c) Vision for your community

d) Vision for your country

e) Vision for Africa and the World

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Part F: Your opinion
(We value views from every person. Kindly, share with us your thoughts.)

1. How did you know about us?

2. What do you expect from us?

3. What can we do to make this programme more successful?

4. What else do you like to share with us?

Date:

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