2018 JCI Mauritius TOYP ApplicationForm
TheJCIMauritius OutstandingYoungPersonAward(TOYP)servestoformallyrecognizeyoungpeoplewhoexcelintheirchosenfields andcreatepositivechange.Byrecognizingtheseyoungpeople,JCIraisesthestatusofsociallyresponsibleleadersinthisworld.Thehonoreesmotivatetheirpeerstoseek excellenceandserveothers.Theirstoriesofdiscovery,determinationandingenuityinspireyoungpeopletobebetterleadersandcreatebettersocieties.
Allfields arerequiredandmust befilledinEnglish.Applicationswillnotbeacceptedafterthedeadline which is 5 Mayat midnight.
Eligibility
1)Nominees must be between the ages of 18 and 40. Nominees born before January 1, 1978 or afterDecember 31, 2000 are not eligible for JCI TOYP. A copy of the National ID Card or Birth Certificate should beenclosedalong with the application form.
2)The nominee should be a citizen of the Republic of Mauritius
3)The nominee must be a resident of the Republic of Mauritius and be present in Mauritius during the judgingprocess and for the Awards ceremony.
4)The nominee should not be a current member of the JCI Mauritius board at the International, National or Local level.
5)The nominee/ nominator must attest to all facts contained in the form and grant permission for publication of thesefacts. The nominee may be required to attend the JCI TOYP Awards Ceremony in Goa, India, if selected as a 2018Honoree.
6) All information must be contained on the application form. Video clips,Scrapbooks, audiotapes, etc. are not used inthe judging process. However, if a candidate is selected as one of the ten international honorees, theseitems will be requested by JCI World Headquarters.
Application Documents
- Agoodquality,4"x6"(10cmx15cm)black-and-white,head-and-shouldersphotographmustbesubmittedalongwiththeofficialnominationform.
ThisfilemustbeinJPGFormatandcannotbegreaterthan2MBofsize.
- National Identity Card orBirthCertificate:
AcopyoftheID/BirthCertificateshouldbeattachedalongwiththenominationform
ThisfilemustbeinJPGFormatandcannotbegreaterthan2MBofsize.
- Application Form:
Application form must be signed by Nominee and Nominator
Unsigned application form will be rejected.
PART1-NOMINATIONFORM
Please Select Category:
□Business,economic,and/orentrepreneurialaccomplishment
□Political,legal,and/orgovernmentalaffairs
□Academicleadershipand/oraccomplishment
□Culturalachievement
□Moraland/orenvironmentalleadership
□Contributiontochildren,worldpeace,and/orhumanrights
□Humanitarianand/orvoluntaryleadership
□Scientificand/ortechnologicaldevelopment
□Personalimprovementand/oraccomplishment
□Medicalinnovation
Part 1A. PersonalBusiness Information(Tobefilledby nominee)
(*) Required Field
NOMINEE’SFIRSTNAME:*
(asitappearsinI.D.)
NOMINEE’SSECONDNAME:*
(asitappearsinI.D.)
TITLE:*
(Dr./Mr./Mrs./Ms./PHD,etc.)
NAMETOAPPEARONTHETROPHY:*
(yournameandany professionaltitle(suchasDoctor)EXACTLYasyouwishit toappearonyourtrophy, inthevideo,andanyothermaterialproducedforthe2017TOYP Programincasetheyouwillbeselectedasoneof thehonorees.)
BIRTHDATE(DD/MM/YYYY):*
HOMEADDRESS:*
EMAILADDRESS:*
HOMETELEPHONE:*MOBILENUMBER:*
OCCUPATIONORPROFESSION:*
BUSINESS NAME(IFAPPLICABLE):
BUSINESS ADDRESS(IFAPPLICABLE):
BUSINESS TELEPHONE:
EMAIL ADDRESS:
EDUCATION(DEGREES, ACADEMICHONORS,ETC.):*
CIVIC,FRATERNAL,ORGANIZATIONSANDAFFILIATIONS:
PUBLISHED WORKS:
Part 1B. Nominee’s Career information (to be filled by nominee)
(*) RequiredField
Outlinethecareerofthenominee,includingbackgroundonthenominee’sworkorfieldofactivity.*
(Word limit is 200 words)
Provideinformationwhichwillhelpthejudgesunderstandthechallenges,problems,andscopeofthenominee’sareaofactivity.*
(Word limit is 300 words)
Describethenominee’sexceptionalachievementsorcontributionsinhis/herchosenfield*
(Word limit is 200 words)
Listpublicstatementsfromauthorities,honors,andawardsreceivedwhichaffirmthenominee’sachievementsorcontributions.*
(Word limit is 100 words)
Part 1C. To be filled by Nominator**
(*) RequiredField
Summarizethenominee’smostoutstandingeffortsthatexemplifytheprincipleexpressedinthefollowinglineoftheJCICreed:“Thatserviceto humanityisthebestwork oflife.”*
(Word limit is 400 words)
Summarizewithinthisspacewhyyoubelievethatthenomineeshouldbeselectedasoneof
TenOutstandingYoungPersonsoftheWorldfor2018*
(Word limit is 200 words)
Nominator**
- Anominatorisareferee,someonewhocanbeartestimonyto yourachievements(oronespecific),otherthan yourself,itmaybeamemberofyourentourageoryourfamily.
- A nominator can also be awell-establishedpublicfigureorrespected/renownedprofessionalinhis/herdomain.Itcanbeasuperiororaco-worker.
- AlternativelyanominatormaybeamemberofJCI.
Part2. DECLARATION
The Following section should be completed by the Nominee
Iattesttoallfactscontainedinmynominationformandgivepermissionforthefactstobeusedforpublication.InagreeingtoacceptaJCITOYPAward,Iunderstandthat,barringextremecircumstances,I amrequiredto bepresentfromOctober 30,2018to November3,2018,fortheJCITOYPCeremonyandactivitiesatthe2018JCIWorldCongressinGoa, India.Intheeventthatcircumstancespreventmyattendance,Imustpresentthe conditionstothe PresidentofJCI foradecisionon the continuedeligibilityofmynomination.
Signature of Nominee: …………………………………….………… Date: ……..………………
Name of Nominee:………………………………………………………………………………..
The Following Section must be completed by the Nominator
Name of Nominator:………………………………………………………………………………..
Telephone: …………………..…….. Email: ……………...………………………………………………..
Occupation/ Profession:………………………………………………………………………………..
If JCI Member, Name:……………………………………………… Chapter: ……………..…….
Signature of Nominator:…………………………………….………… Date: ……..………………
Name of Nominator:………………………………………………………………………………..
FOR OFFICE USE
Name of National Organisation:
Signature of 2018 TOYP Project Director: Date:
Signature of 2018 JCI Mauritius National President:Date: