NMBMELC Cohort 6 Application

1
Full Name* This field is required.
First Name
Last Name
2
Date of Birth* This field is required.
Date
Year
Month
Day
3
District & County of Residence* This field is required.Ex. District #2, Montserrado County
4
Email* This field is required.Make sure you put in your most active and accessible email address here.
example@example.com
5
Phone Number (s)* This field is required.Please add WhatsApp to any number currently registered to your account. Ex. +231770101010 (WhatsApp) / +231880101010
6
Current School Name* This field is required.If you are not currently attending a school, put last attended by the school name. Ex. Jacob Memorial School - Last Attended (2024)
7
College Status/Senior High Class* This field is required.If you are not currently attending a school, put last attended by the status or class. Ex. Grade 12 - Last Attended (Graduated)
8
Emergency Contact Name & Relationship to You* This field is required.Ex. Mr. Nagbe Doe - Father
9
Which one of these houses/courses you passion resonates with most?* This field is required.Kindly select the house of your passion!
Please Select
Please Select
The House of Entrepreneurship - Entrepreneurial Leadership
The House of Diplomacy - Leadership in Diplomacy
The House of Activism -Leadership in Activism
The House of Climate Change _ Leadership in Climate Change
The House of Citizen Journalism - Leadership in Citizen Journalism
Please select carefully.
10
Why should we select you to participate in our leadership program, especially in that house?* This field is required.In 3 to 4 sentences maximum, convince us why you're special.
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11
How would you apply the skills and knowledge gain from your specialized leadership training?* This field is required.In 3 to 4 sentences maximum, convince us on what impacts you will make after completing the campaign.
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12
Knowing that our training is online, can you confirm that you will ensure data availability to attend classes?* This field is required.We kindly ask you select "Yes" as we wouldn't provide data for your classes.
Please Select
Please Select
Yes
No
13
Knowing that our training is self-sustaining, can you confirm that you will ensure paying the $50 program cost by October 29, 2025 latest?* This field is required.We kindly ask you select "Yes" and ensure payment as we depend on those funds to keep running the digital platform and arrange physical items (Radio Talk-shows, T-Shirts, Certificates, Awards and Graduation)
Please Select
Please Select
Yes
No
14
Upon signing this form, I hereby confirm that all details given above are accurate and internet (data) plus the program cost are my financial responsibilities!* This field is required.
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