Transforming yourself and your community

APPLICATION FORM
For the Commutiny Learning and Leadership Journey

Please complete and return this form to: Eligibility Criteria:

COMMUTINY–THE YOUTH COLLECTIVE,
st
1 Floor, 11/8, Nehru Enclave East,
New Delhi-110019
Ph: 011- 26447608
or
Download the form from www.commutiny.in
and email the word format of the file to
applications2010@commutiny.in
th
Submission Deadline: June 30 2010
1
Age - 18 to 30 years and a minimum 6 months
previous experience of active engagement with social
issues.
Please feel free to add more sheets or more space in
order to express yourself adequately.
We really want to know who you are. So please be
frank and open.
1
age as on 30th June 2010

Note: Please make sure you have read through the fellowship details
before filling this form.
PERSONAL DETAILS
Name

Date of Birth (DD/MM/YY)

and Age as on 30 June 2010

Current Address

Permanent Address

Tel. No.(Permanent)

Mobile no.
E- mail

Nationality

Sex

How did you come to know about

this Programme

Social issue you desire to address

COMMUTINY 2010-2011 Application form Page 1

 EDUCATION (beginning with the most recent):

Course Year Institution University/ %

From To /school board age

LANGUAGE SKILLS (please tick level of proficiency):

Languages Speak Read Write

Hindi
English
Any other (specify)-
Any other (specify)-

WORK EXPERIENCE (paid and voluntary, starting with the most recent):
Organisation Period (Month Description of work
and Year)
From

To
From

To
From

To
Total years of work
experience

Have you applied to The Commutiny Learning and Leadership before? In which year did you
apply?

COMMUTINY 2010-2011 Application form Page 2

ABOUT YOU

Tell us who you are.

You may like to include some of the major influences/experiences that shaped and
inspired your path in life, your worldview, and your current concerns and passions (400-
500 words).

COMMUTINY 2010-2011 Application form Page 3

LEARNING AND LEADERSHIP ENDEAVOURS
Share some learning areas you desire to work on for your own growth and development
and to strengthen your social engagement.[400-500 words]

COMMUTINY 2010-2011 Application form Page 4

As a COMMUTINEER, you will have 1 year to work full time to design and lead a social
change experiment of your choice.

Tell us in about 600-1000 words, what would be the experiment that you will take up.
Also include why you chose the particular experiment, what are the social concerns that
you would like to address and how.

COMMUTINY 2010-2011 Application form Page 5

Please share how you will go about implementing your social change experiment, what
will be the key outcomes of your efforts. Tell us what is the most important personal
learning you hope to have through this engagement.

How do you see COMMUTINY- THE YOUTH COLLECTIVE participating in/supporting

your Learning and Leadership endeavours?

COMMUTINY 2010-2011 Application form Page 6

GOING FORWARD
What do you see yourself doing after graduating from the Commutiny Learning and
Leadership Journey?

ADDITIONAL INFORMATION
Any other significant information that you would want to share.

Have you taken support from anyone for filling this application? What was the nature of
support?

COMMUTINY 2010-2011 Application form Page 7

REFERENCE
Please give two referees with names and addresses. The referees should be people you
have worked/working with or studied/studying under.

First Referee Second Referee

Full Name:__________________________
Address:____________________________
___________________________________
___________________________________
Tel No. :____________________________
Email: __________________________
Occupation:______________________
________________________________
Relationship:______________________
________________________________
Full Name:__________________________
Address:____________________________
___________________________________
___________________________________
Tel No. :____________________________
Email: __________________________
Occupation:______________________
________________________________
Relationship:______________________
________________________________

Many development sector organizations/ Networks are always on the lookout for
reaching out to youth from across the country for self development processes or
recruitment. At CYC we plan to set up an online database of young people [based on
LLJ applications] to enhance visibility for suitable linkages.

Please tick below to offer your consent for:

• Putting up your personal details on the online database. _____
• Also including your work experience and interest areas on the online database. ____
• Also sharing your LLJ application form when sought by an agency. ______

DECLARATION

I hereby declare that all the above entries made by me are true to the best of my
knowledge.
I understand that signing this form does not entitle me to be part of this programme.

SIGN DATE

THANK YOU FOR FILLING THIS FORM.

COMMUTINY 2010-2011 Application form Page 8