The Institute for Economic Empowerment of Women.

First (Given) Name (required)

Last (Family) Name (required)

Name As It Appears on Passport (required)

Name you prefer to be called

Address (Permanent Residence, not business or P.O.) (required)

City, Town or Village (required)

Country (required)

Home Phone (include country code) (required)

Cellular Phone (include country code) (required)

Email (required)

What year did you graduate from PEACE THROUGH BUSINESS?(required)
2007200820092010

Person to be notified in case of emergency:(required)

Emergency contact phone number: (required)

Emergency contact e-mail address: (required)

Do you have any family members applying for the 2011 Peace through Business Program?(required)
 Yes No

If so, what are their name(s)?(required)

Do you have any family members in the United States or Canada?(required)
 Yes No

If so, where do they live?(required)

List all organizations you are involved in, social, professional and honorary.
(required)

Name of Your Business(required)

Business Address(required)

Please attach a copy of your government business license or certificate. File types must be pdf, jpg or gif and 500KB or less. (required)

How many years have you owned your business? (required)

What are you most passionate about in your business?(required)

Did you submit quarterly reports for the year following your graduation?(required)

If not, why?(required)

How have you paid forward your PEACE THROUGH BUSINESS training?250+ words(required)

How has your business benefited from your training?(required)

How many new employees have been hired since attending PEACE THROUGH BUSINESS?(required)

How much increase in revenue have you had since attending PEACE THROUGH BUSINESS training?(required)

How do you feel you can assist the IEEW staff with the 2011 program?(required)

Please upload a non-passport photo of yourself. File types must be pdf, jpg
or gif and 500KB or less. (required)

By checking "yes" below, if selected for the PEACE THROUGH BUSINESS program,
I hereby consent to the participation in and publication of interviews, the recording of interviews, photographs, movies or video tapes. I also grant the Institute for Economic Empowerment of Women (IEEW) the right to publish and distribute such materials for publicity purposes in any media format. Media formats include, but are not limited to, newspapers, magazines, television, radio, film, text or any type of media on the Internet. I also grant IEEW the right to edit such materials, so long as the meaning of statements and interview are not changed.(required)
 Yes No

PLEASE DO NOT APPLY FOR THIS CONTEST IF YOU ARE UNABLE TO TRAVEL JULY 8 - 28, 2011

Once you successfully submit your application by pressing the button below, you will receive a confirmation e-mail.