360/OS Digital Leadership Fellows Application

360/OS Digital Leadership Fellows Application

DFRLab's 360/Open Forum || Brussels, December 7-8, 2020
Please fill out the application form carefully and note that the DFRLab will select only FIVE Digital Leadership Fellows based on pertinence to the event's mission. The selected Digital Leadership Fellows will be invited to attend 360/Open Summit and all travel expenses will be covered.
Personal Information
Full Name*

First NameLast Name
E-mail*
Gender*

MaleFemaleNon-binaryPrefer not to say
Organization
Job Title
Nationality*
Type of Organization*

StudentAcademiaNGO, Civil Society Organization, Think TankMediaOther
Please indicate if you have any dietary restriction. If you have allergies or religious dietary requirements, please specify them in the "other" field.

VegetarianVeganDairy-freeGluten-freeOther
For the following questions, how you tell your individual story is what matters most, not the quality of the footage itself. If you have issues submitting a video for any reason, please reach out to the DFRLab at 360@AtlanticCouncil.org.
In a short video (MAX 45 SECONDS), please tell us what democracy means to you:*

Browse Files
mp4 Cancelof
In a short video (MAX 60 SECONDS), please tell us how you're using social media and technology to advance your activism:*

Browse Files
mp4 Cancelof
Please indicate your handle on Twitter, Instagram, YouTube, Facebook, Tumblr, Snapchat, Pinterest, ...
To help us reserve your hotel room and flights as part of your Digital Leadership Fellowship, please indicate the following:
Check-in Date:

DayMonthYear
Date
Check-out Date:

DayMonthYear
Date
Location you would be traveling from/to:
Disclaimers
The videos from submitted applications might be used to create informational and promotional material for the event. Please let us know if you have anything against your video being used for the described purposes.*

All good!I wish for my video to remain private
During the event all participants will be able to download a 360/Open Summit APP. If you wish to be featured in the participants list and be able to exchange your contacts through the App's digital business cards, please agree to share your contact information below (full name, organization, job title, email). This information will not be used for any purpose other than to facilitate networking during the summit.*

Yes, I agree to share my contact information with fellow participantsNo, I don't agree
Please indicate if you're interested in receiving updates on DFRLab's and external publications, future events and program initiative:

I would like to subscribe to DFRLab's newsletter "The Source"
The information you provide will be kept secure and will only be used for the purpose of administrating the event. Your information will never be shared with a third party without your explicit permission. Once the event is complete, we will anonymize all personal information stored and save only a minimum data set for statistical purposes. This is to provide historic information to improve future events, and is not intended for any other purpose. Do you consent to the use of your personal information for the facilitation of this event, as described above?*

Yes, I consent
Should be Empty:

360/OS Digital Leadership Fellows Application

Personal Information

Disclaimers