Youth Leaders for Knowledge and Development Nomination Form

Nominated by (Name/Organization): ___________________________________ Sector (Select one) Military Academe Business Non-Profit/Civil Society Media Arts & Culture Religious Government (pls. specify)_________________ Other (pls. specify)_________________

Family Name

Given Name

Middle Initial

Home Address

Birthday Company/Organization

Phone Number

Mobile Number

Email Address Position/Designation

Interests (You can choose more than one)

Arts & Culture Business & Finance Economic Development Education Environment Health Information Technology Infrastructure Internal Relations Media & Communications Politics & Government Rural Development & Agriculture Social Entrepreneurship Urban Development

ATTACHMENTS Updated CV: 3-5 Power Point Slides about yourself, i.e. leadership experience, community involvement, awards & recognition (printed copy must be attached and a soft copy must be emailed to ateneoylse@gmail.com) On a separate document, please answer the following questions: 1) What is your vision for the Philippines? (maximum of 100 words) 2) What are the key development issues of our country today? How should these issues be addressed and what do you see is your role in addressing these issues? (Maximum of 300 words) 3) What can you contribute if given the chance to be one of the Youth Leaders for Knowledge and Development? (100 words or less) Endorsement letter from nominating institution/individual CERTIFICATION I certify that the above information is complete, true and correct to the best of my knowledge and belief. I understand that any false statements will disqualify me from participation in the YLKD-II selection process. ___________________________
(Signature of Nominee)