CGI U 2010 Table Facilitator Application
CGI U 2010 Table Facilitator Application
Application
Name
*
Title
First
Last
Suffix
Date of Birth
*
/
MM
/
DD
YYYY
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Afghanistan
Albania
Algeria
Andorra
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
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Brazil
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Canada
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Chile
China
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Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
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Ghana
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Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
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Kenya
Kiribati
North Korea
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Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
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Vanuatu
Vatican City
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Vietnam
Yemen
Zambia
Zimbabwe
Country
Email
*
Phone
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Mobile
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Title/Position
Organization/School
Have you ever attended a CGI meeting before?
*
Yes
No
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?
*
Yes
No
Are you a current student at the University of Miami?
*
Yes
No
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.