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BOLD Application Form
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Personal Information
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Page 8
First Name
*
Last Name
*
Email
*
Mobile Phone Number
*
Please include country code (+387)
Gender
*
Female
Male
Other
Date of Birth
*
Country of Birth
*
Skype ID (Leave blank if you do not have a Skype account)
City of Birth
*
Citizenship
*
Current place of residence
Address
*
City
*
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Georgia
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Kosovo
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Virgin Islands, U.S.
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Country
*
Postal Code
*
Medical, Dietary, Disability or other Personal Considerations:
Please describe any pre-existing medical conditions, including any prescription medication the candidate may be taking, or any other dietary or personal consideration. This will not affect candidate selection, but will enable the host institution to make any necessary accommodations. If none, leave blank.
How did you hear about the BOLD Program?
*
Website of the U.S. Embassy in BiH
Incubator or Startup Hub
Network 20/20's website
LinkedIn
Recommended by a colleague/friend
Academic Instution
Browsing the internet
Other
Please select one option
Family Residing in the U.S.
*
Yes, I have close family members residing in the U.S.
No, I do not have close family members residing in the U.S.
Other
If yes, please also check the "other" checkbox and include the name of your family member and city/state (Example: John Doe – Chicago, IL)
Have you traveled to the U.S. before?
*
Yes, I have traveled to the U.S. before.
No, I have not traveled to the U.S. before.
Other
If yes, please also check the "other" section and indicate the duration; when did visit take place month/year; purpose of the visit
Name of University, City
*
Major/Field of Study, Department
*
example, IT Management, Management Department
Grade Point Average
*
Current Year of Study
*
Press ctrl or ⌘ (in Mac) while clicking to select multiple options.
Select options
First
Second
Third
Fourth
Fifth
If graduated, see below question
When did you graduate?
Please indicate month/year
Awards and Honors
List any awards, formal academic recognition, or other certificate of achievement. (Please add multiple lines if needed)
Emergency Contact Name and Relationship
*
Example: John Doe, Father
Emergency Contact Phone Number
*
Please include country code
Internship or volunteer experience
Please add additional experiences below
Memberships in Associations, Clubs, etc., if not included in internship and volunteer experience
Please add additional experiences below
LinkedIn Profile
Select of areas of greatest interest (Up to three sectors should be selected)
*
Agriculture
Artificial Intelligence
Augmented Reality
Consumer Products and Services
Cryptocurrency
Education
Energy
Entertainment
Environment
Financial Services
Fintech
Healthcare
Human Resources
Lifestyle and Wellness
Logistics and Transportation
Manufacturing
Marketing and Advertising
Retail and E-commerce
SasS Software
Security
Other
Up to three sectors should be selected
Evidence of English Fluency - Please note if you have taken a language proficiency test, lived abroad, or taken English language courses. If you have taken any language proficiency test please provide the date it was taken and your test score if you have taken English language courses please indicate your level of English in the course OR indicate your English proficiency using the Common European Framework for Languages (CEFR)
*
Link to the Common European Framework of Reference for Languages is below
Tell us about yourself and how your personal experiences have influenced your educational and personal ambitions
*
Do you have an idea for a business model or project (profit or non-profit) that you want to implement in your community to improve the economy. How do you expect this experience will affect your community? How will it affect you personally and benefit your career goals? If you do not have a specific idea, please think of a challenge in your community that you feel passionate about. What skills would you need to develop in order to address and potentially resolve this challenge?
*
Common European Framework of the Reference for Languages (CEFR)
Please submit along this completed application one letter of recommendation from someone who knows you well and can attest to your personal, academic, or professional experience and ambitions
*
Please send as .doc or .pdf file
The BOLD Program includes in-person and online meetings that will take place in the Spring/early Summer prior to the trip to the United States. If you are selected for the fellowship, will you be able to commit and attend the mentioned segments of the program prior to the visit to the United States?
*
Yes
No
The BOLD Program includes a visit to the United States towards the end of the summer of 2020. If you are selected for the fellowship, will you be able to commit to a five week program in the United States?
*
Yes
No
If selected to the BOLD Program, I understand that I will be part of a diverse cohort with a multi-ethnic and multi-religious background
*
Yes
No
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