CGI U 2010 Table Facilitator Application

Application
Name * Title First Last Suffix
Date of Birth * / MM / DD YYYY
Address *
Street Address

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City

State / Province / Region

Postal / Zip Code

Country
Email *
Phone *

Please do not use any dashes.
Mobile *

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Title/Position
Organization/School
Have you ever attended a CGI meeting before? *
If “yes,” in what capacity did you attend?

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Have you ever served as a CGI or CGI U table facilitator before? *
Are you a current student at the University of Miami? *
Please explain your interest in serving as a CGI U 2010 table facilitator. *

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Please select the global challenges where you feel qualified to lead discussions. You may select multiple options. * Education Environment & Climate Change Peace & Human Rights Poverty Alleviation Public Health
Please describe your experience with the global challenges you have selected. *

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Please select the approaches to solving global challenges where you have experience. You may select multiple options. * Advocacy & Media Community Development Education & Training None
Please describe your experience with the approaches you have selected.

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Please use this space to describe any experience you may have that would prepare you for leading table discussions and facilitating dialogue. *

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Waiting List: At this date, there may not be remaining spots on the facilitation team for some topic areas. If this is the case for your topic area, would you be willing to be added to a waiting list, and be willing to serve on short notice? Yes, please place me on a waiting list if there are no remaining spots.
Please upload a resume or short bio.