WIEF YOUNG FELLOWS PROGRAMME

2 Floor, Kompleks Antarabangsa Jalan Sultan Ismail 50250, Kuala Lumpur, Malaysia Tel: +603 2145 5500 Fax: +603 2145 5504 Web: www.wief.org
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APPLICATION FORM 2012

Who can apply Fresh graduates, young entrepreneurs, civil society leaders, community workers, researchers, junior professionals, who are between the ages 20-25, and have a seed of an idea that they want to develop into a full-grown project. Preference will be given to applicants who can demonstrate how this Programme will directly benefit them, their community and their country. Proficiency in English is required. If you are accepted you will be required to participate fully in the discussions and role-plays in English.

How to apply WIEF Young Fellows Programme 2012 is a free of charge event. Successful candidates need to pay only for their flights. Accommodation and transportation during the programme period, programme materials and basic meals are covered by the organizer. Please send these details to the postal address above or via email at maizura@wief.org: 1. 2. 3. 4. completed application form below your CV letter of recommendation passport-sized photo

CLOSING DATE OF APPLICATION: 31 July 2012 Applicants will be notified of the outcome of selection latest on 7 August 2012 (earlier applicants will be notified earlier.) Participants are responsible for arranging and funding their round-trip travel from home country to Malaysia. No request for financial support can be considered. Participants are expected to seek financial support from their own organization and/or other foundations.

Participation As an annual programme, we only have spaces for 20 young leaders every year. It is a privilege if you are selected for this programme as you are chosen amongst hundreds of applicants. We therefore expect you to commit yourself fully in the programme, and attend all the programme sessions. Cancellations Please think before you register. Make sure you really can make the time to participate because if you cancel at the last minute, it is one opportunity lost to a young leader out there.

WIEF YOUNG FELLOWS PROGRAMME

2 Floor, Kompleks Antarabangsa Jalan Sultan Ismail 50250, Kuala Lumpur, Malaysia Tel: +603 2145 5500 Fax: +603 2145 5504 Web: www.wief.org
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PERSONAL INFORMATION Title: (Mr, Mrs, Ms etc.) Male/Female: Age: Country of Residence: CONTACT DETAILS Postal Address: Name: (Please underline family name) Date of Birth: Country of Birth/Nationality:

City: Country

State: Postal Code:

Phone Number: (including country code) Mobile Number: (including country code) Fax number: (including country code) Email Address: Alternative e-mail address: PASSPORT / IC (Malaysian) DETAILS Passport / IC Number: Country Issuing Passport: WORK EXPERIENCE (if any) Name of organization/cause you work for/are associated with : Citizenship: Issue Date: Expiry Date:

Current Position (include specific job responsibilities if any):

WIEF YOUNG FELLOWS PROGRAMME

2 Floor, Kompleks Antarabangsa Jalan Sultan Ismail 50250, Kuala Lumpur, Malaysia Tel: +603 2145 5500 Fax: +603 2145 5504 Web: www.wief.org
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Milestones at work (awards or recognition won):

Outline briefly the reasons why you would like to participate in the WIEF Young Fellows Programme 2012. Please explain how this program relates specifically to you and or your work or situation.

Where do you see the impact of your acquired skills from this Programme, in your community/country/workplace?

Describe briefly an idea, campaign or a project on which you are, or have worked, or would like to work on that you think you want to share and develop in this programme.

EDUCATION What level of education have you completed? Please mark X in the appropriate square Name of academic institution:
(Please list all colleges, universities, and professional schools attended, stating the year of attendance for each.)

Secondary / High School

Technical / Vocational

Diploma

Undergraduate Degree

Postgraduate Degree

Degrees/courses successfully completed:

(Please list the names of degree courses/certificate earned, including the year awarded.)

WIEF YOUNG FELLOWS PROGRAMME

2 Floor, Kompleks Antarabangsa Jalan Sultan Ismail 50250, Kuala Lumpur, Malaysia Tel: +603 2145 5500 Fax: +603 2145 5504 Web: www.wief.org
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Academic awards (if any): (Please list awards earned during study e.g. Deans Top Student Award, Best Student in Faculty etc.)

Other training, including previous conferences/programmes attended: (Please give details)

LANGUAGE Is English your mother tongue? YES ( ) or NO ( )

(If your mother tongue is not English, please answer all the following questions as fully as possible.) How have you learnt English? How often do you use English? Where do you use English? Rate your English ability using the scale: 1=fair, 2=good, 3=excellent Spoken English: ______ Written English: _______ Comprehension: _________

Please write a short essay on If I have the power to change the world. (one page, minimum 1000 words)

WIEF YOUNG FELLOWS PROGRAMME

2 Floor, Kompleks Antarabangsa Jalan Sultan Ismail 50250, Kuala Lumpur, Malaysia Tel: +603 2145 5500 Fax: +603 2145 5504 Web: www.wief.org
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REFERENCE LETTER ( Enclosed or Sent separately ) Please include a letter of recommendation from your referee. Your reference should be from the head of your organization/immediate work supervisor/university lecturer/head of your project. Letter should be a maximum of one page in length. Please ask your reference to address the following questions: 1. 2. 3. 4. 5. What is the role of the applicant in their organization? Will the applicants participation in this program impact positively on his/her work? Why do you feel this candidate will benefit from WIEF Young Fellows Programme 2012? Please confirm English proficiency of applicant. Please include any other information you think is relevant.

WIEF YOUNG FELLOWS PROGRAMME

2 Floor, Kompleks Antarabangsa Jalan Sultan Ismail 50250, Kuala Lumpur, Malaysia Tel: +603 2145 5500 Fax: +603 2145 5504 Web: www.wief.org
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Referee Details Name: Organization: Address: Relationship: Email: Phone: (including country / district area codes) How did you hear about this Programme?

SPONSORSHIP (FOR OVERSEAS PARTICIPANTS) You will need to consider whom to approach to sponsor your travel expenses. Do you have funding for travel expenses? If you do not have funding, do you need an acceptance letter to help secure funding? TRAVEL INSURANCE All participants from outside Malaysia must have their own travel insurance. The cost of medical care in Malaysia is expensive. If you do not have travel insurance then you may not able to attend the program. (to be provided once accepted
and flight booked )

Name of Insurance Company: ______________________ EMERGENCY CONTACT INFORMATION Name: Relationship to candidate: Tel: Mailing address:

Policy number: ______________________

Email:

Position and Organization: (please state the position, and the name of your organization)

WIEF YOUNG FELLOWS PROGRAMME

2 Floor, Kompleks Antarabangsa Jalan Sultan Ismail 50250, Kuala Lumpur, Malaysia Tel: +603 2145 5500 Fax: +603 2145 5504 Web: www.wief.org
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CONSENT Do you give us consent to use the information provided in this form to write a short biographical paragraph about you that will be given to trainers, participants and others for the purposes of informing them, seeking funding on your behalf, advertising this programme and in future WIEF Young Fellows Programme 2012 publicity material? YES ( SIGNATURE AND PHOTOGRAPH I certify that the information I have provided on this application form and in any attached materials is true and complete. Full signature Date: ________________________________ __________________ ) or NO ( )

Please attach passport photograph

Thank You for Your Application! ______________________________

About WIEF The WIEF Foundation, a not-for-profit organisation based in Kuala Lumpur, organises the annual World Islamic Economic Forum, a world-class business platform showcasing business opportunities in the Muslim world, and to run programmes of the various initiatives of the Foundation that strengthens people partnership and knowledge exchange between Muslim and non-Muslim communities across the globe. The Foundation aims to tackle problems in the Muslim world strictly from a business perspective, and to build bridges through business between the Muslim and non-Muslim world.