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THIS IS THE APPLICATION FORM FOR THE MOMENTUM / CILL INTERNATIONAL LEADERSHIP COURSE, 20-29 JUNE 2022

The Centre for International Learning and Leadership (CILL) and Momentum World have been running international leadership courses since 2010. These courses have become recognised as some of the best personal and professional development programmes available to young people.

The 2022 course is divided into two strands:
A) Leadership for Social Action - suitable for young people interested in social, community, youth, ecological or other 3rd sector employment or activity
B) Leadership for Young Entrepreneurs - suitable for young people who want to start their own business or to understand the world of business and enterprise.

When you complete this application, you will need to say which group you want to join, and why.

To apply for this course, you should be aged 21-30. If you are older or younger than this, you may still apply but we may ask for additional justification. You will need a good level of working English (B2 upper intermediate or above). There will be an intensive programme of activities, requiring energy, team work and commitment. We will reject applications which do not show clear motivation.

If you have any problems or questions concerning this form, please email office@momentumworld.org

All information which you give will be treated in confidence and in accordance with our data protection and privacy policies.

PLEASE NOTE: Completing this form does not guarantee a place on the course. We will contact you to confirm your attendance.

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* 1. Which country do you live in?

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* 2. Title

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* 3. What is your name?

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* 4. What is your gender?

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* 5. What is your date of birth?

Date

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* 6. What is your city or region?

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* 7. What email address do you want us to use to contact you?

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* 8. What is your mobile phone number (including country code)?

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* 9. What is your current status?

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* 10. What is your motivation for joining this leadership course?

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* 11. Which course group do you want to join?

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* 12. Why did you choose that group?

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* 13. Please give us your passport details (non-UK participants only)

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* 14. Please confirm your COVID-19 vaccination status

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* 15. Do you have any disability or assistance needs?

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* 16. Do you have any dietary requirements or allergies?

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* 17. Do you have any medical conditions, or do you take any regular medication, that we need to know about?

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* 18. NEXT OF KIN: Please give details of someone we should contact in the event of an emergency.

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* 19. How did you hear about this course?

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* 20. Do you have any other comments or questions for the training team?

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* 21. DECLARATION
I understand and agree that:
1. I guarantee to stay for the full duration of the course and to participate actively in all activities.
2. Activities may be photographed or recorded, and my image may be used for publicity or promotional purposes. All video and photographic images will only be used in an appropriate way.
3. I will treat other participants with respect, regardless of their national, religious or other background.
4. I will not take any illegal drugs or any other substance except personal medication if prescribed.
5. If I drink alcohol, I will do so only in moderation and with respect to the sensitivities of others.
6. Unless specifically exempted, I will pay a participation fee of €200.
7. I will arrange suitable travel insurance (including Covid-related cover). Momentum World / CILL will not be responsible for any costs resulting from illness, injury or loss.
8. In the event of an emergency, if there is an urgent need, I agree to receive emergency medical treatment (including anaesthetic) if considered necessary by the medical authorities present.
9. Momentum World / CILL may contact me by phone or email in connection with this course.

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