application form - [email protected]

Application for Fellowship Participation
Climate Change Professional Fellows Program
East Asian and Pacific Region | Winter, 2012
Instructions for Application: Please submit this completed form along with:
 a scanned copy of your passport, clearly showing the number and all relevant information;
 a scanned copy of your driver’s license or other U.S. issued identification, clearly showing
all relevant data;
 a passport picture of yourself (white background, head and shoulder shot);
 a letter of approval from your current employer to take a leave of absence;
 your resume; and
 all required documents listed within this application form.
Please send application packets to: [email protected] by December 22, 2011.
For more information about this program, please check our website at
Program Background
The Climate Change Professional Fellows Program is an international fellowship program
which will convene professionals and young emerging leaders from four East Asian and Pacific
countries—Australia, China, Indonesia and Japan—and the United States to explore the science,
impact, adaptation, mitigation and actions related to climate change. The program will serve 32
participants, including 16 from the U.S. and 21 from the other participating countries, in three
exchanges: fellows from abroad will come to the U.S., dividing their time among San Francisco,
New York City and Washington, DC (amongst other cities). These portions of the program
occurred in Spring and Fall 2011. During a three-week period in the summer of 2011, and now
again in the winter of 2012, U.S. Fellows will travel to the East Asian and Pacific Region
(Summer 2011: Australia and China; Winter 2012: Indonesia and Japan). This program is funded
by US State Department’s Bureau of Educational and Cultural Affairs.
The goal of the Professional Fellows Program is to create opportunities for young emerging
leaders and professionals in the field of climate change to come together and share information
and strategies for reducing carbon emissions and move to more sustainable economies.
Participants will exchange ideas and best practices developed in each country, and share
information on education and communication campaigns for those working in urban and rural
areas that are most vulnerable to environmental devastation resulting from climate change.
Details of the Winter Fellowship (Indonesia, Japan)
Baruch College will help select 8 individuals to serve as Professional Fellows and will work with
partners abroad to develop a program of activities while the Fellows are in their country.
Activities will vary from country to country but will focus on climate change issues affecting that
region. It is anticipated that the topics to be included are:
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Application Form for Climate Change Professional Fellows Program
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Addressing challenges of climate change in urban settings, focusing on energy, waste
management, and communication strategies;
Exploring how each country defines climate change problems, the range of solutions they
are exploring, cultural and other constraints and how these issues are communicate to the
population at large; and
The challenges of building sustainable economies while preserving the environment.
Fellows will meet with climate change partners in the country to be visited. The partner
organizations include, but are not limited to, government, NGOs, and business corporations. This
experience will provide the Fellows and the partner agencies with an opportunity to gain insight
and promote information sharing on climate change endeavors.
Fellow Qualifications: Fellows are selected based on outstanding performance and the ability to
play leadership roles in their organizations and in their communities. Partners use a competitive
approach in selecting participants. All applicants must fulfill the following criteria:
Be a citizen of the United States.
Have a strong interest and be actively engaged in climate change issues.
Mid-level professional, young emerging leader, media professional, established
community leader, or government staff.
Be able to participate in the 3 week program: mid-February to early March.
Japan- February 13th – March 2nd
Indonesia – February 20th – March 9th
Demonstrate commitment to community service.
Have approval from current employer to take a leave of absence.
Be able to adapt to new environmental surroundings and challenges.
Financial Support: The program covers airfare, lodging (double occupancy), local travel in the
countries being visited, health insurance for the Fellow only, and a limited number of meals. The
Fellow’s home organization will cover the salary during the fellowship period. There are no
financial responsibilities for international partners serving as a host organization.
Visa: The International Center and Baruch College will work with the U.S. Department of State to
facilitate the visa application process with the U.S. Embassy.
The International Center/Baruch College Contact Information: If you have any additional
questions, please contact Ms. Aisha Khan at [email protected] or 1-646-660-6720.
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Application Form for Climate Change Professional Fellows Program
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Application for the Winter 2012 Fellowship
Participant Information
* Please remember to include a scanned copy of your passport and identification clearly showing all relevant
information. All information below must match the information on your provided passport and identification.
Last Name:
Middle Name:
First Name:
Last Name
Current Address:
Home phone number:
Emergency Contact
(Person we should contact in
case of an emergency during
your fellowship)
Work phone number:
Cell number:
Fax number:
Place of Birth:
Date of Birth:
Skype Name:
Phone number:
Country of Citizenship:
Current Job Title:
Passport Number:
Name of
__________ ___________________
Supervisor at Work
What sector do you work in?
Private Sector
Expiration date:
City & State:
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Application Form for Climate Change Professional Fellows Program
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Please attach your CV or resume to this application.
Letter from Employer
Please include a letter from your supervisor indicating approval to participate in this program.
Language Requirement
Please rate your ability to speak, read, and write in English.
2. Please briefly describe your proficiency in any other languages (including if you have taken a
language proficiency exam, lived abroad, or taken any language courses):
International Experience
Briefly describe any other fellowship opportunities you have participated in (including the
countries you travelled to) and list any other foreign travel you have undertaken:
Experience and Motivation
Please write a separate document with the answers for the following questions (150-250 words for
each question).
1. Why are you interested in being a Climate Change Professional Fellow?
2. Describe where you work and your role and responsibilities. In what ways does your job relate
to climate change? How long have you been in this position? What special skills and
knowledge will you bring to the Professional Fellows Program?
3. Please describe similar projects or campaigns where you have effectively done work regarding
climate change in either your community or workplace and your role in making it succesful.
4. Please describe what areas of climate change are important in the U.S. and/or your community
(Describe only 1 or 2 important areas). Desribe what you hope to achieve during this program.
5. Describe how your participation in this program will benefit climate change progams in the
U.S. and/or your community.
6. Identify your countries of preference for this fellowship, if you have any, and any reasons why
you would like a fellowship in that country (Japan or Indonesia only). Please note that your
response does not guarantee placement in that country.
All application packets should be sent to: Ms. Aisha Khan at
[email protected] by December 22, 2011.
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Application Form for Climate Change Professional Fellows Program
Page 4
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