AFRICAN CLIMATE CHANGE LEADERSHIP PROGRAM (AFRICLIP) 2017 APPLICATION Form details Application Deadline: 30 September 2017 To apply: http://apply.africlp.or.ke/ We appreciate your interest in the African Climate Change Leadership Program (AfriCLP) The AfriCLP Call for Applications document (a separate document) describes the AfriCLP and outlines available Fellowship types, eligibility criteria and additional information that may guide you through the application process. If you have not yet read the Call for Application and Information documents please do before applying online. This Application Form must be completed by every applicant. This Application Form solicits information from the applicant on: 1. Fellowship type and program relevance 2. Personal data 3. Educational background 4. Current employment 5. Publications and awards 6. Project description and budget 7. Supporting documents (that must be submitted with the Application Form to complete your application). Please pay special attention to all application and submission instructions and adhere to word limits (where applicable). Complete those fields that are applicable to you and the Fellowship for which you are applying. Thank you! The AfriCLP program partners AfriCLP - 2017 Application Form 1
Section 1: Personal Data Surname/ Family Name: First Name (s): Gender: Nationality: Country of Residence: Date of Birth (dd/mm/yyyy): Mailing Address: City/Town: Province/ State: Country: Work telephone: Mobile phone: Home telephone: E-mail address: Alternative E-mail address : Section 2: Fellowship Type and Program Relevance 2.1 For this call, the following AfriCLP Fellowships are available. Please mark one of the boxes below to indicate the Fellowship type and thematic focus area for which you are applying (mark only one box). Full descriptions of fellowship types and thematic focus areas are provided in the AfriCLP Call for Applications and Information documents. Research Fellowship Policy Fellowship Climate Solutions Fellowship 2.2 How does the proposed work advance and apply knowledge for climate change adaptation in Africa, particularly with respect to the thematic area that you have selected? (100 words max). 2.3 How does the proposed work aim to advance the goals and objectives of the specific Fellowship type (i.e., Research Fellowship, Policy Fellowship or Climate Solutions Fellowship), as described in the AfriCLP Call for Applications and Information documents? (100 words max). AfriCLP - 2017 Application Form 2
2.4 If you are a researcher or scientist applying for a Research or Climate Solutions Fellowship and intend for the Fellowship to advance your ongoing research or climate solutions product, please clearly define what component or activity of that research would be supported by the Fellowship funds (100 words max). Section 3: Educational Background 3.1 Please provide details below for all completed degrees, as applicable: BSc / BA University: Field / Program: Year obtained: Thesis Title (if applicable): Language of instruction: MA /MSc / MPhil University: Field / Program: Year obtained: Thesis Title: Language of instruction: PhD University: Field / Program: Year obtained*: Dissertation Title: Language of instruction: Section 4: Employment Background Please provide the following information as requested: Current Employment/ Institutional Affiliation: Name of institution: Current position: City and country: Supervisor: Supervisor email: AfriCLP - 2017 Application Form 3
Major responsibilities (150 words max) Previous Relevant Employment Name of institution: Position: Country: Period of employment: Major responsibilities (100 words max): You may insert additional tables, if necessary, to provide information for up to three previous relevant employment positions. Section 5: Leadership Activities Please provide comprehensive, detailed responses to all of the questions listed below as they pertain to your leadership efforts between January 1, 2015 and August, 2017. It is recommended that specific examples be included. Please refer to evaluation criteria at the bottom of this application form. IMPORTANT NOTE: Applicants must demonstrate the role he/she has served with respect to driving and leading the activities referenced in the application. Reviewers will be looking to distinguish the strengths of the actions among the applicants. Therefore, succinctly highlight these. 5.1 Describe one to two (1-2) key initiatives you have led to address climate change (mitigation and/or adaptation), and summarize why you should be awarded this grant. (Max character count: 4,000) 5.2 Provide 1-3 examples of new goals, plans or other actions that you put into place within your institution (not necessarily related to climate change). If there is a relation, be sure to detail how each of the activities referenced in this section will/can be supported through this grant, and your specific role in regard to each of the referenced initiatives. (Max character count: 4,000) 5.3 List up to three (3) relevant membership activities (e.g., NGOs, government partnerships, B2B) in which you are an active member/participant. For each listing, please specify your role (if any) and why it is relevant to this award. (Max character count for description: 1,000) AfriCLP - 2017 Application Form 4
SAMPLE ANSWER: Collaboration Example #1: National Climate Assessment Applicant s Role: Chapter Lead and Author Description: As a chapter lead for the 2016 in the Sudan Climate Assessment, I was able to introduce climate change impacts on rangelands for the first time to the Sudan National Climate Assessment. Working with authors from across sectors East Africa, my work on this program has resulted in important collaborations and future opportunities for getting the universities in the region engaged in the reporting process. Collaboration #1: Applicant s Role: Description: Collaboration #2: Applicant s Role: Description: Collaboration #3: Applicant s Role: Description: 5.4 Provide 1-2 examples of how you have demonstrated leadership in driving and/or supporting the external engagement of your institution with other institutions, noting a particular emphasis on the following criteria. (Max character count: 4,000) Creating effective partnerships with other organizations and individuals from across sectors. Collaborating with peers to develop best practices, influence behavior change, and engage in public education. 5.5 Provide 1-2 examples of how you have demonstrated leadership in driving and/or supporting climate education and training efforts within your organization. (Max character count: 4,000) 5.6 Please provide 1-2 examples of climate thought leadership, such as working to shape policy solutions; articles, books or other publications (Please list up to 5 relevant publications and current and/or previous awards including grants or other Fellowships that you have received). (Max character count: 4,000) 5.7 Are there other specific actions you have taken that have not been covered in the questions above, but that should be considered along with the other information submitted in this application? If so, please describe. AfriCLP - 2017 Application Form 5
6. Fellowship Project and Budget 6.1 Project concept note (5 pages maximum): At this stage, a brief concept note is required that describes the proposed work to be supported by an AfriCLP Fellowship. Applicants selected to receive an AfriCLP Fellowship award will be required to submit a full proposal, agreed upon by AfriCLP Management, before the Fellow takes up their Fellowship. Please prepare and submit, together with this Application Form, a project concept note that describes the following: a) title of the project; b) objectives and rationale that describe the goals and purpose of the project; c) methodology describing how the research will be conducted and what methods will be used; d) statement on who the research is expected to impact and how the research results will be linked to potential users of the information; e) expected outcomes and outputs of the proposed project; and f) work plan outlining the activities to be completed, including a clear timeline that indicates the proposed Fellowship period (i.e starting and ending dates) and project milestones 6.2 How do you expect to benefit as a result of receiving an AfriCLP Fellowship (100 words max)? 6.3 How do you expect your country to benefit as a result of you receiving an AfriCLP Fellowship (200 words max)? 6.4 Please describe plans for work following the Fellowship experience that will enable you to expand, improve and make more effective your contributions to advancing climate change leadership in Africa. 6.5 Project Budget. The budget should outline all project related costs in relation to, for example, travel for data collection; materials and supplies; and facilities & administrative costs, as appropriate. Please adhere to budget maximums for your Fellowship type, as described in the Call for Applications. Please use the table below as a budget template. Budget Item Unit No. of units Unit cost Total Cost AfriCLP - 2017 Application Form 6
Materials Equipment Data Communications Domestic travel Other (list): Project Implementation Sub-total: International Travel RT airfare to city of Host Trip 1 Institution Visa fee Other (list): Sub-total: Lodging Food Other (list): Living Expenses Month Month Sub-total: Other E.g., Course registration fees Other (list): Course Sub-total: Budget Total: Section 7: Supporting documents Individual Leadership Award applicants require third-party references. Files may be uploaded together with the application. The following supporting documents must be provided: a) At least two (2) third-party reference forms (REQUIRED) AfriCLP - 2017 Application Form 7
o At least one reference should be provided from an individual within the applicant s institution (preferably the same department or division). o At least one reference should be provided from an external partner institution that the applicant has collaboratively worked with. o Institutional Support Form (to be submitted by a representative of applicant s home institution). This form must be completed by the Head/Departmental Head/Supervisor in your Home institution. This must be sent by the institutional representative directly to the AfriCLP Secretariat. This form is required for all Fellowship types; the only exception is Post-Doctoral Applicants who are not mandated to have a Home institution. Please download the Institutional Support Form at www.africlp.or.ke. b) Examples and full copies of publications authored by the applicant (articles, white papers, op-eds, etc.) and/or recent speech transcripts. Submitting your application Please visit Call for Applications for detailed submission instructions. Applicants are urged to adhere closely to all guidelines. All application materials must be received submited online no later than 30 September 2017. Application Checklist Application form (attach a PDF) Project concept note (5 pages maximum; attach a PDF) Project budget Institutional Support Form (to be sent by the institution directly to the Secretariat) Two (2) Reference forms (to be sent by the referees directly to the Secretariat) Academic certificates AfriCLP - 2017 Application Form 8
Appendix: Eligibility Requirements Applicants for the African Climate Leadership Award must meet the following eligibility requirements: General Eligibility Requirements a) Applicant's institution must have significant presence/operations in any African Country. Applicant's institution must meet one of the following descriptions: o Legally-recognized organization in any African Country; or o Governmental entity or academic organization in any African Country. b) Applicants must have been students/employed and reside within Africa. Considerations for Evaluation: Applicants will be evaluated based on the following attributes that are deemed to exceed business as usual: a) Innovation, strategic management, and thought leadership in addressing climate change. b) Key climate (or closely associated) initiatives led by the applicant, and subsequent goals, benchmarks and plans for measuring success implemented by applicant. c) Quality of engagement with non-profit partners, government organizations, and/or other non-advocacy collaborations. d) Quality of collaboration with peers to develop best practices, influence behavior change, establish standards, and engage in public education. e) Education and training of internal staff and management, as well as external stakeholders, partners and suppliers. f) Academic qualifications and achievements. g) Strength and relevance of Concept Note. AfriCLP - 2017 Application Form 9