• Home
  • Who We Are
    • Mission and Vision
    • From the President
    • History
    • Team
    • Board of Directors
    • Board of Advisors
    • Annual Reports
    • Partnerships
    • Funders
  • What We Do
    • Our Approach
    • Economic Empowerment
    • Global Youth Programs
    • Peace and Dialogue
    • Social Entrepreneurs
    • Our Impact
  • Our Programs
    • TechGirls
    • Professional Fellows Program
    • Global Youth Village
    • Saudi Young Leaders Exchange Program
    • LivingSideBySide Programs
    • Emerging Young Leaders Award
    • Community Building & Social Cohesion
    • Youth Leadership Programs
    • Past Projects
  • Get Involved
    • Teams of Excellence™
    • Host an International Visitor
    • Employment & Internship Opportunities
    • Newsletter
    • Donate
    • Contact Us
  • Global Transformation Corps
  • Virtual Programming
    • A Letter From Legacy Founder & President J.E. Rash
Legacy International
 
  • facebook
  • Twitter
  • linkedin
  • YouTube
  • instagram
  • email
  • Donate

Sign Up for our Newsletter

 
  • Home
  • Who We Are
    • Mission and Vision
    • From the President
    • History
    • Team
    • Board of Directors
    • Board of Advisors
    • Annual Reports
    • Partnerships
    • Funders
  • What We Do
    • Our Approach
    • Economic Empowerment
    • Global Youth Programs
    • Peace and Dialogue
    • Social Entrepreneurs
    • Our Impact
  • Our Programs
    • TechGirls
    • Professional Fellows Program
    • Global Youth Village
    • Saudi Young Leaders Exchange Program
    • LivingSideBySide Programs
    • Emerging Young Leaders Award
    • Community Building & Social Cohesion
    • Youth Leadership Programs
    • Past Projects
  • Get Involved
    • Teams of Excellence™
    • Host an International Visitor
    • Employment & Internship Opportunities
    • Newsletter
    • Donate
    • Contact Us
  • Global Transformation Corps
  • Virtual Programming
    • A Letter From Legacy Founder & President J.E. Rash
Legacy International > Professional Fellows Questionnaire

Professional Fellows Questionnaire

The following questionnaire will help Legacy’s team prepare for your five week stay in the U.S. Your responses will be used for assuring your well-being and comfort during your visit.
Please use as much space as you need, and answer the questions with as much detail as possible. This information will be kept confidential. Please complete the questionnaire by Sunday October 9th. If you have questions, please contact: aaleavitt@legacyintl.org

Step 1 of 4

25%
  • Participant Background Information

  • (Your legal name as listed on your passport. This is how it will appear on such documents as a certificate of participation, airline ticket etc.):
  • If applicable, please enter the name or nickname you want to be called on this Program:
  • Date Format: DD slash MM slash YYYY
  • country code - city code- phone number
  • In case of emergency, whom should Legacy contact?
  • country code - city code- phone number
  • country code - city code- phone number
  • Alternate emergency contact, if person listed above is not reachable.
  • country code - city code- phone number
  • country code - city code- phone number
  • (For example: no shellfish, no dairy, halal, kosher, vegan, etc)
  • (For example: 1 pack a day, only at night after dinner, etc.)
Save and Continue Later
  • Health Questions

    All medical information is kept confidential and only shared with others on a “need to know” basis. You will be provided with medical insurance to cover the costs of medical care in the US, should the need arise. It will not cover the costs of routine medical care or treatment for any pre-existing medical or dental condition. (Details will be provided at a later date.)
  • (For example, allergic to pollen, shellfish, peanuts, dogs, cats, mold, medications)
  • (If you require epinephrine for treating severe allergic reactions, please note this and be sure to bring this with you.)
    AllergyTreatment 
  • (For example: hard of hearing, difficulty walking up stairs, difficulty standing for long periods, etc.)
  • (For example: diabetes, asthma, heart disease, recent fracture which may affect mobility, etc.)
  • NOTE: Please be sure to bring enough medication to last your entire U.S. stay.)
Save and Continue Later
  • Technology Use

  • If yes, we strongly recommend that you bring your laptop (or tablet)
Save and Continue Later
  • Program Assessment

    (Please note that your answers to this section will be kept confidential)
  • Check your top 3
  • (Please select all that apply)
  • Please rank the following areas of interest to you personally, from 1 being the most important to 10 being the least important to you
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • 12345678910
  • Please check all the roles that you currently play or have played before. (Please check one box in each role):
  • I have never done thisAttend meetingsHelped plan activitiesLead events or activitiesTrain othersHeld a leadership positionStarted a new group or organization
  • I have never done thisAttend meetingsHelped plan activitiesLead events or activitiesTrain othersHeld a leadership positionStarted a new group or organization
  • I have never done thisAttend meetingsHelped plan activitiesLead events or activitiesTrain othersHeld a leadership positionStarted a new group or organization
  • I have never done thisAttend meetingsHelped plan activitiesLead events or activitiesTrain othersHeld a leadership positionStarted a new group or organization
  • I have never done thisAttend meetingsHelped plan activitiesLead events or activitiesTrain othersHeld a leadership positionStarted a new group or organization
  • Below is a list of different skills and abilities a leader might have. Please rate yourself on the following characteristics. Please check one box in each row.
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • Please rate your current knowledge and skill in these areas. Please mark “X’ in one box of` each row.
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • PoorFairGoodExcellent
  • Please specify below
    PoorFairGoodExcellent
Save and Continue Later
  • Who We Are
    Mission Vision
    From the President
    History
    Team
    Board of Directors
    Board of Advisors
    Annual Reports
    Partnerships
    Funders

 
  • What We Do
    Our Approach
    Economic Empowerment
    Global Youth Programs
    Peacebuilding and Dialogue
    Social Entrepreneurship
    Our Impact
 
  • Our Programs
    TechGirls
    Professional Fellows
    Global Youth Village
    Saudi Young Leaders
    Emerging Young Leaders Award
    Social Cohesion
    LivingSidebySide®
    Youth Leadership Programs
    Global Transformation Corps
 
  • Get Involved
    Teams of Excellence ™
    Host Opportunities
    Employment
    Newsletter
    Donate
    Contact Us