The Institute for Economic Empowerment of Women.

2011 PEACE THROUGH BUSINESS
Student Application

Classes will be held in Kabul, Afghanistan and Kigali, Rwanda.

Acceptance into the 2011 PEACE THROUGH BUSINESS Program is based upon the information submitted in this application. Any incomplete or false applications will not be considered for the program. Please do not submit your application until it is complete, including photos and passport copy.

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)

Married (required)
YesNo

Husband's Name (if applicable)

Do you have any children? (required)
 Yes No

If yes, how many and what ages?

Date of Birth (Month, Day, Year) (required)

Month
JanFebMarchAprilMayJuneJulyAugSeptOctNovDec

Date
12345678910111213141516171819202122232425262728293031

Year
195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988

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

Emergency contact phone number: (required)

Emergency contact e-mail address: (required)

Country of Citizenship (If dual citizenship, list both) (required)

Passport Number and Expiration Date(required)

Attach a copy of your passport. File types must be pdf, jpg or gif and 500KB or
less. (required)

Do you have a current Visa?(required)
 Yes No

If yes, attach a copy of your Visa. File types must be pdf, jpg or gif and 500KB or
less.

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 who have participated in the 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)

Please list all schools you have attended and any diplomas or degrees you have received.(required)

Please list any special skills you have.(required)

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

Please list all languages you speak and degree of fluency.(required)

Please indicate your skill level on the following computer applications.
(This information is very important, as it helps us plan the classes. 1 = no skill,
2 = very little skill, 3 = some skill, 4 = above average skill, 5 = very skilled.)(required)

Keyboarding
12345

Microsoft Word
12345

Microsoft Excel
12345

Microsoft PowerPoint
12345

Accounting
12345

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)

Did you start your business?
 Yes No

If no, how did you obtain your business?

How many years have you owned your business?

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

Where do you see your business in five years?(required)

How many employees do you have?(required)

Are you planning to open a business other than the one described above?(required)
 Yes No

If yes, please explain:

Do you have a job other than your business?(required)
 Yes No

If yes, what steps need to be taken in order for you to work full time
in your business?

Please describe your business in detail. (Please give us details, as this plays a role in our selection process.)

Do you own 100% of your business?(required)
 Yes No

If no, who is your partner(s) and what percentage do you own?

If you do not own a business, you will be eligible for the In-Country portion of the program but will not be eligible to travel to the United States.

What is your annual revenue in USD? (required)

What business skills would you like to gain from attending the
PEACE THROUGH BUSINESS training? (required)

If you are able to spend time with an American Woman Business owner in a business like yours, what would you like to learn?(please be detailed)(required)

Please provide two references that we can contact before admittance into the program.

Reference Name:(required)

Reference contact phone number: (required)

Reference contact e-mail address: (required)

Reference Name:(required)

Reference contact phone number: (required)

Reference contact e-mail address: (required)

Share your story! Your answer must be a minimum of 250 words.
You can either type your answer below or upload a word document Doc
and docx are supported file types.(required)

"Outside of your business, what personal obstacles have you overcome as a strong woman in your country,
and how has overcoming these obstacles made you a stronger woman?"

(Optional.) You can also upload your essay in the form of a word document. File types must be doc or docx and 40KB or less.

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

Please upload at least three (3) photos of your business with this application.
File types must be pdf, jpg or gif and 500KB or less. (Photos of you in your business,
with signs or products are preferred.) (required)

(Optional)

(Optional)

(Optional)

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

I understand that if selected for travel to the U.S. for participation in Leadership Development, a $250 (USD) program fee will be required.
 Yes No

Scholarships for the program and visa fees are available based on financial need.

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