IMANI-AFRICAN LIBERTY ACADEMY

About You

*Salutation:
*First name:
*Last name:
*Date of Birth:
*E-mail:
*Country of Citizenship:

Contact Information:

Your Permanent Address:
*Street:
*City:
*Zip/Postal Code:
*Country:
*Phone:
Cell Phone:

Your Mailing address
*Street:
*City:
*Zip/Postal Code:
*Country:
*Phone:

Where do you prefer to be contacted?
Mailing Address Permanent Address

Academic Information:

*Your College/University:
*Major or Graduate Program:
Date/Expected Date of Graduation*
*Grade Point Average (on 4.0 scale):
Academic Reference
*Name:
*E-mail:

You and Us:

*Have you attended an IMANI seminar before?

Yes, I am an IMANI Alum!
Year Attended
Seminar Attended

No, I am new!
How did you learn about IMANI?

*Have you attended an African Liberty event Before?

Yes, I am an African Liberty Alumi
Year Attended
Seminar Attended

No, I am new!
How did you learn about African Liberty?

Respond briefly to the following questions in hundred and fifty words or less:

ALA aims to inspire you to think critically about how political and economic decisions, especially by governments affect you. Should government alone decide what is best for you? This is not a YES or NO answer. Please answer in 150 words only?

What skills, abilities, & education do you possess that qualify you for ALA? Please answer in 150 words only.

How do you plan to use the knowledge and skills gained from ALA? Please answer in 150 words only.

*I agree to adhere to African Liberty's Rules during the seminar
Please enter your name:

Note: We will not evaluate incomplete applications.

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