Application Form - Instructions for Applicants

Cambridge Coexist Leadership Programme (CCLP)

Application Registration Form

In order to process your application, we ask that you complete the questions below.

We are asking some of these questions now, to save us from asking them again, should you come onto the CCLP.

PART A: Personal Details

If your application is successful, we will share the information you give in the fields below with our residential venues in order to meet their security and our catering requirements.
Title:
First Name:
Surname:
Familiar Name:
(if any)
Job Title & Organisation:
Religious/Denominational Background:
Date of Birth:
Home Address:
Home Telephone Number:
Work Address:
Work Telephone Number:
Preferred E-mail Address:
Mobile Telephone number:
If you have any particular dietary requirements (eg Halal, Kosher,vegetarian etc.) please inform us of them below:
If you have any particular special needs arising from issues of health please inform us of them below:

PART B: Car Details

Should your application be successful, and you are likely to travel to any of our programme venues by car, please state below your car make, model and registration number, so that we reserve you a car-parking space (where possible). Should these details change while you are on the programme, please notify us immediately so that we may update our venues.

PART C: Mini-Biography

Please use the space below to describe yourself by way of a pen-profile or mini-biography in no more than 150 words. Shouldyourapplication be successful,we will circulate this description to fellow participants and other CCLP stakeholders.

PART D: Passport-Sized Photograph

Please could you paste below, or put as an attachment to the email in which you send us this completed form, a digital, passport-sized photograph of yourself which you would be happy for us to circulate to friends and stakeholders of the CCLP programme, if you are selected.

PART E: Referees

We need details of two referees who will be informed of your application and available to speak to us by phone in support of your application.

Referee 1

Name:
Relationship to you:
Address:
E-mail:
Phone:
Instructions on when best to contact the referee:

Referee 2

Name:
Relationship to you:
Address:
E-mail:
Phone:
Instructions on when best to contact the referee:

Please return this form to along with your CV or an equivalent list of past employment and a short paragraph explaining your motives in wanting to participate on the CCLP programme by the application deadline given on the website.