Eco-Champions application Form About You First Name: * Make sure your first name is correct and corresponds to the one on your passport. If you are selected this information will be used to issue the invitation letter to apply for a visa. Last Name:* Make sure your last name is correct and corresponds to the one on your passport. If you are selected this information will be used to issue the invitation letter to apply for a visa. Date of Birth:* Make sure your date of birth is correct and corresponds to the one on your passport. If you are selected this information will be used to issue the invitation letter to apply for a visa. Include your date of birth below in the following format: DD/MM/YYYY Attach birth certificate or its equivalent to validate your DoB:* Gender:* Make sure your gender corresponds to the one on your passport. If you are selected this information will be used to issue the invitation letter to apply for a visa. Male Female City of residence:* Country of residence:* Email:* You can write either your email address, the email of your parent/legal guardian, or of any adult you trust (e.g. SOS Children's Villages staff). Phone Number:* Include your Nigeria country prefix; that is, +234 Do you receive support from SOS Children’s Villages in Nigeria?: Yes No If you replied Yes to the question above, please select the SOS Children’s Villages programme you are benefiting from. Family-Like Care (Village) Family Strengthening Programme SOS Vocational SOS Hermann Gmeiner School SOS Youth Facilities Semi-Independent Living Other (please specify) How would you describe your English level from 1 - 5? 1 means that you can't speak, understand or read any English while 5 means that you are a native English speaker and/or feel very comfortable speaking, reading or writing about complex issues in English. Do you identify with any of the following situations? You can select more than one option. There is no right or wrong answer. We are looking for Eco-Champions with limited access to opportunities who are committed to addressing climate change within their communities. I have limited support or connection with my parents and family I don’t have adequate parental care, or I am at risk of losing it I am currently studying at university or similar My highest level of Education is secondary or primary school I would like to continue my studies, but I cannot afford it at the moment I have a part-time job I have a full-time job I am financially independent I have participated in similar programmes, trainings or similar opportunities I consider myself part of a marginalized community in Nigeria (due to ethnicity, gender, religion, indigenous communities, disabilities, etc.) I have regular access to stable Internet and devices None of the above applies. Other Do you have any disability that we should be aware of?: Please note that we aim to make the programme as inclusive as possible. Your youth-led initiative or idea Now we want to learn more about the climate initiative that you are either already leading or have an idea about. don't worry if you have not put it in practice yet, what we value the most is your idea and commitment! 💪 What is the name or title of your youth-led initiative?: Describe your initiative in one sentence (yes, one sentence 😉): What is the climate-change-related problem you identified in your local community? What are you doing (or plan to do) to improve the situation? Don't forget to explain how this problem is affecting people in your community. Which UN Sustainable Development Goal (SDG) is your youth-led initiative tackling?? Please select all the SDGs that apply. The UN Sustainable Development Goals (SDGs) are 17 global goals set by the United Nations to make the world a better place by 2030. They focus on things like ending poverty, protecting the planet, and ensuring everyone has peace and prosperity. To learn more about the SDGs and why they are important: https://sdgs.un.org/goals No Poverty (SDG 1) Zero Hunger (SDG 2) Good Health and Well-being (SDG 3) Quality Education (SDG 4) Gender Equality (SDG 5) Clean Water and Sanitation (SDG 6) Affordable and Clean Energy (SDG 7) Decent Work and Economic Growth (SDG 8) Industry, Innovation, and Infrastructure (SDG 9) Reduced Inequality (SDG 10) Sustainable Cities and Communities (SDG 11) Responsible Consumption and Production (SDG 12) Climate Action (SDG 13) Life Below Water (SDG 14) Life on Land (SDG 15) Peace, Justice, and Strong Institutions (SDG 16) Partnerships for the Goals (SDG 17) Please explain how your youth-led initiative is (or will be) contributing towards the SDGs you have selected above Is someone else (especially other youth) working on this initiative? Please select all the options that apply: I am leading this initiative by myself I am jointly leading this initiative with other young people. At least half of the young people working on the initiative with me identify as women or girls. At least half of the young people working on the initiative belong to a marginalized community (due to ethnicity, religion, etc.) At least young person working on the initiative (not me) is supported by SOS Children’s Villages. Have you already put in practice your initiative? If so, when did you start? How have members of your community, especially youth, benefited (or will benefit) from your initiative so far? How many people have been (or will be) impacted by your initiative? What are the most significant achievements of your youth-led initiative? Please try to be specific on the results you have achieved. And if you haven't got any results yet: what are the results that you aim to achieve in the first year? Additional information about your youth-led initiative. For example, you can include a website, article or brochure about your initiative, your personal motivation to drive your initiative, your next activities, etc. Your personal motivation and commitment We want to know YOU! Tell us your personal story in 100 words or less. We would love to get to know you better: what in your life made you so interested on climate issues and eager to lead a climate initiative? Is this the first time you are engaging in climate action or have you already taken any action before? Please describe any previous experience or projects you have been involved in related to climate action. How did these experiences impact your understanding and commitment to addressing climate challenges? Please confirm below whether you can commit approx. 10 hours per month from September 2024 to October 2025 to actively participate in the online and face-to-face activities for Eco-Champions programme? Yes No Not 100% sure Please confirm below whether you can attend the face-to-face Eco-Champions Summit in Nairobi (Kenya) from November 24th – 29th? Yes No Not 100% sure Data Collection SOS Children’s Villages Nigeria will process your personal data or the data of the minor you are responsible for (such as name, address, date of birth, gender, phone number or email address) collected in the application form. The data will be used only to the extent necessary for the organization of Eco-Champions programme and used exclusively to process the booking of flights and accommodation, to issue the visa as well as for communication purposes. The processed data will be stored in the SOS Children's Villages database. In the case of applicants who are younger than 16 years old, we need a signed consent form from their legal guardians in order to consider their application. Do you consent with your personal data (or the data of your child) being processed as described above? Yes No If the applicant is younger than 18 years old, please submit together with this application a signed copy of the consent form. If you don’t have the consent form, please request it from SOS Children’s Villages staff. Attach consent form if you are less than 18 years old: Submit