BEL Application

*There are NO FEES to apply or participate in the program if you are selected. However, U.S. applicants may pay a small travel fee*

NOTE: WE WILL NOT CONSIDER INCOMPLETE APPLICATIONS. PLEASE MAKE SURE YOU SUBMIT REQUIRED DOCUMENTS

First Name

Middle Name

Last Name

Date of Birth

Gender

Female Male

Street Address

City

Department

Country

Phone Number

Alternate Phone Number

Name of Business or Organization:

Department (Business location)

How long has your company been in operation?

Is your business legally registered in Haiti?

Yes

Please attach copy of registration or patent certificates

What is your company's annual revenue?

Attach proof (if any)

Number of employees

Industry

Ex: Agriculture, Textile, Construction, Healthcare, etc..

Do you have any training in this field?

Highest Level of Formal Education

Description of what your company or organization does:

What problem is your organization solving or seeking to solve?

Why should you be chosen to participate in this program?

What do you hope to get out of this program?

Please list any associations/organizations that you or your business are a member of

Ex: Chamber of Commerce, business clubs, women associations, etc..(provide proof of membership if possible)

Emergency Contact (Haiti)

First Name (Emergency Contact, HT)

Last Name

Phone Number

Email Address

If applicable

Street Address

City

Postal Locality/District/Department

Country

Emergency Contact (United States)

First Name (Emergency Contact, US)

Last Name

Street Address

City

Country

Phone Number

Email Address

If applicable

Please attach supporting documents

Please select all of the supporting documents you are submitting today

Reference Letter

Head-shot photo (requirement)

Copy of Passport (if applicable)

Copy of Visa (if applicable)

Business Registration/Incorporation certificates (if applicable)

Proof of revenue (if applicable)

WE WILL NOT CONSIDER INCOMPLETE APPLICATIONS

By providing my signature and checking the box below, I understand that If I have misrepresented or omitted any facts relative to this application, I can be denied or discharged from this program. I also commit to helping Haiti become a developed nation through my talents and efforts.

*There are NO FEES to apply or participate in the program if you are selected*

Please note that if safe travel is not possible at the time of the BEL Fellowship, this program will be conducted virtually

You must check the box to proceed

I Understand & Agree

Signature

Date

How did you learn about BEL Initiative?

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BEL Application

Emergency Contact (Haiti)

Emergency Contact (United States)