Youth Empowerment & Innovation Program (YEIP) — Africa & Middle Eastat HRH PRINCESS BELLE RACHEL FOUNDATION Application Form Gender *First Name *Last Name *Date of Birth Valid ID or Pass number *Email Address *Phone number (including country code) Address Address Line 1Address Line 2CityState / Province / RegionZip / Postal CodeAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKosovoKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis and FutunaWestern SaharaSamoaYemenZambiaZimbabweCountryHighest Level of Education Completed Field of Study / Major Institution Name Year of Graduation (or Expected) Current occupation *StudentSelf-employedUnemployedEmployedOrganization / Business Name Position / Role Briefly describe your work or business Name of your Project or Innovation Brief description of the project (150-250 words) Which sector(s) does your project fall under? (tick all that apply) *Agriculture HealthEducationDigital / TechnologyCreative industriesOther What problem are you addressing? (100-150 words) *What is your innovative solution? (100-150 words) *What are the expected outcomes / impact of your project? (100-150 words) *What is the current stage of your project? *IdeaPilot / prototypeOperating business / venture Other Number of people your project currently reaches What is the scale/ambition of the project Who are your target beneficiaries? *Have you received prior funding or support for this project? *YesNoIf yes, please give details Why do you believe you (or your team) are well placed to deliver this project? (100-150 words) *How does your project empower youth (including you) and/or promote youth innovation? (100-150 words) *How will the project be sustainable beyond the initial support period? (100-150 words) *What support do you currently need? *Please list two key performance indicators (KPIs) you will use to measure success *Are you applying as an individual or as part of a team/organisation? *IndividualTeam OrganisationIf part of a team/organisation, please provide the Team/Organisation Name Website / URL is the organisation registered? YesNoIf yes, registration number Brief background of your team/organisation (100-150 words) *Have you worked with youth before (either as founder, employee, volunteer)? If yes, please describe CV / Resume * Drop your file here or click here to upload You can upload up to 1 files. Project Concept Note * Drop your file here or click here to upload You can upload up to 1 files. Recommendation Letter Drop your file here or click here to upload You can upload up to 1 files. Please confirm you meet the eligibility criteria: I am between 18-30 years oldI am a citizen/resident of a country located in Africa and/or Middle East.I commit to participating fully in the program for its durationAttachments (tick what you’re submitting) CV / Resume of applicant/leadBusiness/project planPrototype/demo link (if any)Reference letter(s)Is there anything else you’d like us to know about your project or you as applicant? (max 150 words) How, where, or from whom did you hear about our foundation? *Declaration and Consent *I hereby declare that the information provided above is accurate and complete. I understand that providing false or misleading information may result in disqualification. I give permission to HRH Princess Belle Rachel Foundation to collect and store the submitted data and to verify the information provided. I consent to the processing of my personal data for application and coordination purposes. I agree to abide by the HRH Princess Belle Rachel Foundation’s policies, values, and code of conduct.Date / Time *Signature (Full name) *PhoneSubmit
Youth Empowerment & Innovation Program (YEIP) — Africa & Middle Eastat HRH PRINCESS BELLE RACHEL FOUNDATION
