Ashoka Young Changemakers USA Nomination/Application Form

Ashoka Young Changemakers USA Nomination/Application Form

Basic Details

First Name

Last Name

Gender

Self Identify

Date of Birth (dd/mm/yyyy)

Phone

Other Phone

Address Details

Country

Street

City

State

Provinces

State/Province

Zip/Postal Code

Education

Are you currently in school?

YesNo

If so, what grade are you in?

Academic Institution

Your Changemaking Experience

What is the problem or issue you are addressing? Why do you care about it? How has it affected you?

What did you do about it? Describe the solution you created to solve the problem

What is your initiative called?

Where does your work happen?

State(s)/town(s)/region(s)

When did you begin working on your initiative? (DD/MM/YYYY)

Who have you involved? What does your team look like and who does what?

Who has provided you with guidance or support in launching/growing your initiative?

What is different today because of your initiative? Please describe the impact you have been able to create.

What impact do you hope to see in the next 3 years and how do you want to measure it?

Looking Ahead

What have you learned through your changemaking experience of launching your own initiative?

Through the process of launching and leading your own initiative, do you feel you have greater power to solve problems you are witnessing/experiencing in your day to day life? Please explain.

Ashoka’s vision is to have “an everyone a changemaker world”. This is a world in which we all realize our power to create change. Ashoka would like to invite changemakers such as yourself to co-create ideas to give as many young people as possible the opportunity to experience being a changemaker.

Why are you interested in being part of this movement?

What are some specific ideas you have to help your peers have a similar experience pf tackling the problems they care about? Please share some specific ideas (if any) you would like to champion towards the “everyone a changemaker” movement?

Documents upload

Share any links about your initiative.

Upload a video or photo of you or your team

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