2016 “48 Hours as a Diplomat” Student

ROTARY INTERNATIONAL
Inter Country Committee
USA - FRANCE
USA Section
« Avec le patronage de la Commission nationale française pour l’UNESCO »
2016 “48 Hours as a Diplomat”
Student Participant APPLICATION FORM
“48 Hours as a Diplomat” is A Collaborative Peace-Building Workshop organized by
Rotary International France-USA and USA-France Inter-Country Committee. It will be held in Paris,
France on September 29, September 30, October 1, and October 2, 2016. Travel, lodging, meal and
workshop expenses for selected student participants will be paid for by USA-France Inter-Country
Committee. The workshop will be conducted in English. In order to be considered, the applicant must
complete this application and submit it to [email protected] by January 30, 2016. In order to be
valid your application must be endorsed by a Rotary Club.
Student Participants should at least be engaged in a master’s degree at the time they participate in
the program. Applications from PhD students will be considered as well.
 Five students from France: Students specialized in international affairs and/or students who intend to work in
the field of diplomacy. Participants will be selected by the France-USA Inter-Country Committee.
 Five students from the U.S.: Students specialized in international affairs and/or students who intend to work in
the field of diplomacy. Participants will be selected by the France-USA Inter-Country Committee.
APPLICATION CHECKLIST
Submit a complete application and make copies for your records.
Application form including a Rotary Club endorsement.
Two essays
Résumé or CV, attached (including a digital photo with file name as applicant name)
Applicant’s Certification
ROTARY INTERNATIONAL
Inter Country Committee
USA - FRANCE
USA Section
« Avec le patronage de la Commission nationale française pour l’UNESCO »
APPLICATION FORM
Applications must be made through a Rotary district. Please consult your local club or district for the application deadline and procedure.
Applications must include: all completed sections of this application, written essays, a résumé, and a signed certification. Please type. Do not
use initials or abbreviations. Please use Roman characters.
Legal Name
__________________________________________________________________________________________________________
Last/Family/Sur First/Given Middle (complete) Other Names
Male
Female
Date of Birth _________________________________________
Country of Citizenship____________________________________ Country of Birth (if different) ______________________________
Preferred Phone Number _______________________________________________________________________________________
Email Address _______________________________________________________________________________________________
Permanent Home Address
Number and Street Apartment #
_________________________________________________________________________________________
City/Town State/Province_________________________________________ Country Postal Code
________________________________________
Emergency Contact Name______________________________________________________________________________________
Relationship_________________________________________________________________________________________________
Phone________________________________________________ Email Address ________________________________________
Address
Number and Street Apartment # ______________________________________________________________________________________________________________________________
City/Town State/Province _________________________________________________________ Country Postal Code _________________________________________________________
ROTARY CLUB ENDORSEMENT
Rotary Club Name ________________________________________________________ Rotary District Number _____________________________________________
Rotary Club President Name ____________________________________________________________________________________________________________
Signature
____________________________________________________________________________________________________________
WRITTEN ESSAYS
You are required to submit written essays with your application. Each essay should be no more than 500 words.
ROTARY INTERNATIONAL
Inter Country Committee
USA - FRANCE
USA Section
« Avec le patronage de la Commission nationale française pour l’UNESCO »
1.
What significant events in your life, including professional and volunteer experience, have influenced your desire to work in the
field of peace and conflict resolution? Include a summary of your principal interests and activities as they relate to your career
goals :
2.
How have you taken on leadership roles during your academic and/or professional life? How have these leadership skills
enhanced your community-oriented and/or service-oriented work?
RÉSUMÉ OR CURRICULUM VITAE
You are required to submit a current résumé or curriculum vitae with your application form.
ROTARY INTERNATIONAL
Inter Country Committee
USA - FRANCE
USA Section
« Avec le patronage de la Commission nationale française pour l’UNESCO »
APPLICANT’S CERTIFICATION
I hereby apply for the USA-FRANCE ICC “48 Hours as a Diplomat” Peace Project. I certify that I am eligible to apply, understanding that
persons in the following categories are ineligible: (a) Rotarians or honorary Rotarians; (b) employees of a Rotary club or district, of Rotary
International, or of another Rotary-affiliated entity; (c) spouses, lineal descendants (children or grandchildren by blood or legal adoption),
spouses of lineal descendants, or ancestors (parents or grandparents by blood) of any living person in categories (a) or (b); and (d) former
Rotarians and their relatives as described above within 36 months of resignation.
If I receive the USA-FRANCE ICC “48 Hours as a Diplomat” Peace Project opportunity, I agree:
1. To immediately sign the intent to participate form and pledge commitment to attend and participate.
2. To learn about Rotary International and do the following as part of my duties as a Peace Project participant:
• Speak to various Rotary and non-Rotary audiences in my home country and elsewhere, before, during, and after the project period.
• If possible, participate at Rotary events, at which I may be invited to make presentations and enter into group discussions on relevant subjects.
• Encourage and make myself available for media interviews at home and abroad.
3. To promote the USA-France ICC wherever possible and to permit the USA-France ICC to use for public relations purposes my name and all
photographs and written reports generated during my fellowship term
4. To accept funding decisions of the USA-France ICC and to understand that under no circumstances will my project participation funding be
extended beyond the project term.
5. That I will participate in all required academic and social activities prior to the Peace Project.
6. That the USA-FRANCE ICC “48 Hours as a Diplomat” Peace Project provides funding for the stated period.
7. That the fellowship provides funding for the following:
• Airfare and transportation to the event.
• Lodging and meals.
• Supplies while at the event.
8. That I am personally responsible for all costs associated with my spouse or dependents who may accompany me during the project period. If
I elect to travel earlier or stay later, I will be responsible for additional costs.
9. That I must abide by any decisions made by the USA-France ICC concerning the project.
10. That my fellowship may be revoked for any of the following reasons: failure to represent Rotary International in a professional manner;
failure to fulfill my fellowship obligations; failure to submit required reports on time; evidence of misconduct; failure to follow the directions of the
USA-France ICC; failure to honor speaking engagement requests of local Rotarians; or any contingency that prevents me from fulfilling all the
obligations of the fellowship.
11. That Rotary International, the USA-France ICC, individual Rotary clubs/districts and Rotarians are in no way liable for my personal welfare or
responsible for enabling me to pursue my studies beyond the fellowship period. Rotary International and the USA-France ICC assume no
responsibility or obligation whatsoever beyond providing the amount of the fellowship.
12. That if awarded the USA-FRANCE ICC “48 Hours as a Diplomat” Peace Project, I will keep the USA-France ICC aware of my
whereabouts from selection until the completion of the project.
13. That the information provided in this application is complete and accurate, and failure to provide complete and accurate information may
result in the revocation of your selection as a participant.
14. That if any of the information provided in this application changes between the date of submission and the date of selection, I will inform the
USA-France ICC immediately. Failure to inform the USA-France ICC of these changes may result in the revocation of my project attendance.
15. US participants only: I will show proof of sufficient health/ accident insurance before departing the USA and a valid Passport.
Name of Applicant (please print): ______________________________________________________
Signature of Applicant: _____________________________________________ Date: ____________