Application to join the International Masters in Leadership for Sustainable Development (Masters in Professional Studies)

The deadline for receipt of completed application forms is 31 May 2004

Please contact the LEAD office to which you are applying for more information.

1. About you

Your full name
(Write your full name as it appears on your passport)
First Name
Family Name
Middle Name
Gender: / Male / Female
Please attach a recent passport photo of yourself with the application form you submit.
Date of birth
City of birth / Country of birth
Current place of residence
City/Town
State/Province / Country
Your email address
Your employer’s website
Your personal website
Your employer’s name
Address
City / State/Province
Country / Zip/Postal Code
Telephone (include all codes) / Fax
Your home address
City / State/Province
Country / Zip/Postal Code
Telephone / Fax
Are you living at present in? / Rural Area / Urban Area
Name and address of someone to contact in an emergency
Name: / Relation:
Address:
City / State/Province
Country / Zip/Postal Code
Telephone / Fax
Where would you like to be contacted? / Work / Home

How did you hear about this programme?

Media advertisement / Through a friend, or LEAD Fellow
Employer / Other – please specify below

Disability/special needs

Please tick in the box provided if you have a physical or sensory disability which might in some way affect your participation in the Programme.

Please provide full details below

2. Your education

Please list your two most recent educational establishments attended, starting with the most recent.

Name and Address / From
Month Year / To
Month Year / Full-time or
Part-time?

Please list all examinations you have taken in chronological order. If you are awaiting the results of any examination taken recently write PENDING in the result column. Continue on an additional sheet if necessary.

Level (for example Bachelors Degree or Diploma) / Subject / Date
Month Year / Place of Study / Results

Please list any other relevant training or other courses you have attended, continue on an additional sheet if necessary

Name and subject of course
Institution
Date of Enrolment / Date of Graduation
City / Country
Briefly describe the course content in the space below

At Forum for the Future and LEAD we use English as our working language so prospective students need to be comfortable with working in English.

An International English Language Testing System (IELTS) score of 7 or above is required for attendance on this programme. Please indicate your skill level in speaking, reading and writing English as examined by a recognised IELTS examination centre.

English Language Examining Body
Score (please attach certificate)

Use the space below to indicate your skill levels in other languages

Language
Speaking
Writing
Reading
Language
Speaking
Writing
Reading

You will also need to be reasonably familiar with using computers, particularly wordprocessing and spreadsheet programs as well as email and web browsing. It would help us if you could indicate whether you have used any of the following types of software for home or work

Databases / Email
Graphics packages / Spreadsheet
Networking / Statistical analysis
Presentation, eg, PowerPoint / Web browsing
Programming languages / Website design
Word processing
How often do you access the internet? / All the time / Sometimes / Rarely

3. Your professional experience

Please list your work experience and employment. Also include your main responsibilities, continue on an additional sheet if necessary

Job Title and main responsibilities / Name of organisation / From
Month Year / To
Month Year / Full time or Part time?

Please indicate your area of professional interests

Agriculture / Business
Climate / Digital divide
Education and cultural values / Energy
Gender / Health
International governance / International relations
Media / Natural resources
Poverty / Waste management
Water resources / Other (please include details below)

4. Essay questions

There now follow 4 essay questions.

a) Use the space below to explain how your completion of this International Masters in Leadership for Sustainable Development programme will advance sustainable development in your country or region.

b) Use the space below to describe your own contribution to, or achievements in, sustainable development issues, paying particular attention to any leadership roles you have played:

c) Students will undertake a variety of group work during the year. Please outline a project proposal of particular interest to you. It should have a short title which conveys the essence of the project. It should cover a topic that you have some knowledge or experience of. You will not necessarily develop this project during the year, but the admissions panel will be looking for innovative, carefully thought out proposals. Maximum 200 words.

d) Use the space below to give a brief explanation of what the concept of sustainability means to you personally. Maximum 50 words.

5. References

Please provide the names and contact details of two referees. Ideally at least one should know your academic work. However, this depends on how long it is since you graduated, but he/she should be able to comment on both what you can contribute to, and gain from, the programme. This referee should complete the confidential statement overleaf. The second referee may be approached at a later stage.
Name
Organisation / Position
How long has the referee known you and in what capacity (personal or professional?)
Address
City / State/Province
Country / Zip/Postal Code
Telephone / Fax
Email:
Name
Organisation / Position
How long has the referee known you and in what capacity?
Address
City / State/Province
Country / Zip/Postal Code
Telephone / Fax
Email:

Signature of applicant

Decisions on applications are made in good faith on the basis that all of the information provided by applicants is accurate and complete. I confirm the documentation which accompanies this application form is my own work. To my knowledge the information on this application is accurate and complete and should I be awarded a place on the Masters Programme, I accept that this is a fast-track intensive programme and apart from exceptional circumstances, no holiday or other time out which is not already timetabled will be possible.

Signature: ______Date: ______

Confidential statement by referee

Name of Referee
Organization / Position
Address
City / State/Province
Country / Zip/Postal Code
Telephone / Fax
Email:
Name of applicant ______
Please comment on: applicant’s suitability for the International Masters Programme in Leadership for Sustainable Development, intellectual qualities, present performance, potential (including leadership potential), personal qualities and cover any contribution you feel they will bring to the Programme as well as any benefit you feel they will gain from it.
Signature: ______Date: ______

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