CSAAE ASSOCIATE APPLICATION FORM

CSAAE ASSOCIATE APPLICATION FORM
Personal Information
Applicant's Name *

First Name Middle Name Last Name
Date of Birth *

Day Month Year
Date Date Picker Icon
Gender *
State of origin *
Town, LGA, State, Nationality
Are you a student ? If yes, answer the following. If no, still answer the questions so that we know where and what you studied. Then tell us at the end your current occupation *

Yes No
Name of Tertiary Institution *
Department *
Faculty *
Year of study or graduation year if you have graduated *
Occupation (if applicable)
How did you hear about C-ASSOCIATE? *
Contact Information
Email *
example@example.com
Phone Number *

Area Code Phone Number

Home Address *

Street Address

City	State / Province
Postal / Zip Code	Country

Reference

(Referee MUST Be an ENL, EAL, C-Associate, CSAAE Board Member, Mentor, Staff or CBEP Consultant)
Name *

Prefix First Name Middle Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Parents/Guardian Information

Answer these if you are below 18 years of age
Name of Parents/Guardian

Prefix First Name Middle Name Last Name
Phone Number of Parents/Guardian

Area Code Phone Number
Ethics Declaration

As an ethics organization, prior to your acceptance as a C-Associate, applicants are required to answer the following questions. All applicants are advised to be truthful in their response as any false statement will lead to immediate disqualification.
Do you belong to any cult group in campus cult? *

Yes No
Are you a female sex worker or belong to any prostitution ring ? *

Yes No
Have you been accused or convicted of prostitution before? *

Yes No
Have you been accused or convicted of kidnapping? *

Yes No
Have you been accused or convicted of any form of robbery? *

Yes No
Have you been accused or convicted of any form of cyber-crime? *

Yes No
Have you been accused or convicted of religious bigotry? *

Yes No
Have you been involved in any form of examination malpractice? *

Yes No
What area of interest would you like to serve as a C-Associate? *
Essay
Why do you want to be a CSAAE Associate? What can you do for Africa through CSAAE? (Not more than 250 words) *

0/0250
Which of these categories do you fall under? *

Ex-Emerging or Effective African Leader Employee, partner or volunteer at CSAAE and its affiliates Participant at paid C-Edu program Participant at paid C-Job program Participant at paid C-Enterprise program Participant at paid CBEP Boot Camp Incorruptible Nigerian Youth Award Recipient YEAP Ethics Essay Competition Winner YEAP Ethics Debate Winner YEAP Ethics Champion Mompreneur Participant at a paid CSAAE and its affiliates' event
Which specific CSAAE and its affiliates' events have you participated in? *
By clicking the "I Agree" button below, I certify that the information contained in this application is correct and agree to abide by the rules and regulations of CSAAE. I understand that false information is ground for rejecting my application. *

I Agree
Should be Empty:

CSAAE ASSOCIATE APPLICATION FORM

Personal Information

Contact Information

Reference

Parents/Guardian Information

Ethics Declaration

Essay