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Country of citizenship:

Age as of January 20, 2012:

Have you attended a YA session before? 

yes no - If yes, which one?

1st/2004 2nd/2005 3rd/2006 4th/2007 
5th/2008 6th/2009 7th/2010  8th/2011
9th YA 10th YA

Are you currently affiliated with an NGO (non-governmental organization)?

yes no - If yes, which one?

If yes, please explain the nature of the work you do within this organization.
(Please limit your answer to 300 words.)

Which MDG area is the primary focus of your interest?

Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Promote youth empowerment & activism Reduce child mortality & improve maternal health Combat HIV/AIDS, malaria & other diseases Ensure environmental sustainability Develop a global partnership for development

Please explain why. (Please limit your answer to 300 words.)

Please tell us why you wish to attend the Youth Assembly:

- What would you like to accomplish while there?

- What do you hope to gain from the experience?

- What do you plan to do with this when you return to your home country?

- What do you bring to the table?

Email Address:

Please make sure you answered each & every question above thoughtfully and in detail. Incomplete application forms will not be reviewed. Your answers will determine whether or not you will be invited to participate in the Youth Assembly, so give each of them thought and make your replies clear and concise.

Applications will be assessed according to the potential and interest you bring to your fellow delegates, not so much your record - so don't worry about past achievements but focus on your future plans!