Yalda-branch-application-form

YALDA BRANCH APPLICATION FORM

The founding member of the branch must complete this application form. Once the application is reviewed YALDA will inform you whether or not your application was successful.

Use as much space as necessary and please be honest and concise. If you have no information to include in some sections of the report, then please leave the area blank, or indicate why you have nothing to include in the section.

For any attachments please email them to yaldafrica@gmail.com with your founder's full name.

Gender (Your name)

Program of Study

A. BRANCH FOUNDER'S DETAILS

Full Name

Skype ID

Primary Phone/Mobile Number

Email Address

Graduation Year

Why do you want to start a YALDA branch at your university? (in 150 - 250 words)

How did you hear about YALDA?

Facebook or Twitter

YALDA Member

Attended YALDA Conference

Other

Physical Mailing Address

Please highlight your previous work with youth (in 150-250 words)

B. PROSPECTIVE BRANCH CONTACT INFORMATION

Official Name of Prospective Branch

Name of University or Institution of Prospective branch

Country Institution is Based

Registration Date at University

Date of Branch First Launch Eventr

C. PROSPECTIVE EXECUTIVE COMMITTEE DETAILS

a) FACULTY ADVISOR 1 FULL NAME *

Title and/or Department *

Email *

Contact Number *

b) FACULTY ADVISOR 2 FULL NAME

Title and/or Department

Contact Number

c) EXECUTIVE DIRECTOR FULL NAME *

Year *

Email *

Contact Number *

Skype *

d) DEPUTY EXECUTIVE DIRECTOR/ SECRETARY FULL NAME *

Year *

Email *

Contact Number *

Skype *

e) FINANCIAL DIRECTOR FULL NAME *

Year *

Email *

Contact Number *

Skype *

f) LOCAL UNIVERSITY COORDINATOR FULL NAME *

Year *

Email *

Contact Number *

Skype *

g) INTER-UNIVERSITY REPRESENTATIVE FULL NAME *

Year *

Email *

Contact Number *

Skype *

h) RESEARCH DIRECTOR FULL NAME *

Year *

Email *

Contact Number *

Skype *

i) INTERGOVERNMENTAL ORGANISATIONS LIAISON FULL NAME *

Year *

Email *

Contact Number *

Skype *

j) MULTIMEDIA SPECIALIST (GRAPHICS DESIGER/ WEB MASTER/ IT OFFICER) FULL NAME: *

Year *

Email *

Contact Number *

Skype *

DECLARATION

I hereby declare that the information provided in this application is accurate and complete. I authorize the Youth Alliance for Leadership and Development in Africa to use the information above for the purposes of the assessing the branch registration.

Yes No

Reset

Yalda branch application form