APPLICATION FORM

National Selection of Young Champions of the Earth 2019 Indonesia

1. Eligibility screening

Please tick the boxes below to indicate that you are in agreement with the following statements.
*I am willing to be an ambassador for Young Champions of the Earth, making time to inspire others and tell my story by
participating in interviews/videos and social media when required

I have read the contest rules.

I have a valid passport.
I am willing and able to travel internationally.
I will be between 18 and 30 years old (inclusive) on 31 December 2018.
I have already attempted to implement my big idea for at least 6 months.
I am willing to be an ambassador for Young Champions of the Earth*

2. Personal details of the applicant

1 First Name
2 Last Name
3 Date of Birth
4 Sex
5 Nationality
6 Country of Residence
7 Mobile number including
country code
8 Email Address
9 Vocation (if applicable)
10 Organization (if applicable)

3. Summary
1 Title of your big idea
(Up to 150 characters including spaces)
2 Summary of your big idea
(Word Count: 0 / 150)
3 Short biography – tell us a bit
about yourself
(Word Count: 0 / 100)

1|Page
4. Selection Criteria
Each application will be judged according to the same criteria: the 3 Ps (People, Planet and
Prosperity); demonstrated commitment; the 3 Cs (Curious, Courageous and Colourful); and the
strength of the referee’s recommendation.

4.1 The 3 Ps
Planet and people
Your innovation should be good for society and the environment. We are looking for ideas that will
have a real, measurable impact on the health of the planet while supporting the needs of both
present and future generations.
1 How is your big idea good for
society and the environment?
Please cite the specific
environmental and social
challenges that you seek to
address.
(Word Count: 0 / 400)

Prosperity
Even the best ideas will go nowhere if the numbers don’t add up. Your innovation should be
financially viable, whether through revenue generation, support from grants, or other funding
sources.
1 How is your big idea financially
viable and how do you intend to
spend your $15,000 seed
funding? Please be specific.
(Word Count: 0 / 200)
2 Please list the details of any
funding or grants (and the
amount) that you have received
to date for your big idea.
(*If there are none - please state so.)

4.2. Demonstrated Commitment

1 To be eligible to enter this
competition, you are required to
have already attempted
implementing your big idea for a
period of at least 6 months. To
date, how far have you
progressed? Do you have
preliminary research results?
Have you conducted any trial
runs or created a prototype?
Have you received any accolades
or expressions of support? Please
be as specific as possible.
(Word Count: 0 / 300)

2|Page
4.3. The 3 Cs
Curiosity drives us to forge new paths and develop innovative solutions. Colorful personalities
radiate with quirky ebullience that can inspire collective action. Courage empowers us to challenge
vested interests, pursue unconventional ideas, and fight for the health of our planet and its people.
Hence we are seeking curious, colorful and courageous individuals.
1 How do your past achievements
demonstrate that you are
capable of thinking out of the
box, exercising the power of
persuasion, and fighting
fearlessly for a better world?
Please cite any prizes won or any
relevant multimedia produced by
or about you.)
(Word Count: 0 / 300)

5. The 2030 Agenda for Sustainable Development

On 25 September 2015, countries gathered at the United Nations Sustainable Development Summit
in New York adopted a set of 17 Sustainable Development Goals to end poverty, protect the planet,
and ensure prosperity for all as part of a new global development agenda. Each goal has specific
targets to be achieved by 2030. Which three Sustainable Development Goals does your big idea
most meaningfully contribute towards? Please tick three goals.

1. No Poverty

2. Zero Hunger
3. Good Health and Well-Being
4. Quality Education
5. Gender Equality
6. Clean Water and Sanitation
7. Affordable and Clean Energy
8. Decent Work and Economic Growth
9. Industry, Innovation and Infrastructure
10. Reduced Inequalities
11. Sustainable Cities and Communities
12. Responsible Consumption and Production
13. Climate Action
14. Life Below Water
15. Life on Land
16. Peace, Justice and Strong Institutions

3|Page
 17. Partnerships for the Goals
6. Campaign Alignment
UN Environment runs a number of communications campaigns. Are any of them relevant to your
big idea? Please tick which ones. If none of them are relevant, do not worry as this will not affect
the evaluation of your application.

Breathe Life - aiming to improve air quality in cities.

Wild for Life - combatting wildlife crime.

Clean Seas - reducing marine plastic pollution.

Coral Reefs - saving the world’s remaining coral reef habitats.

7. Mentoring Needs
Are you interested in gaining access to an expert community to receive inputs and guidance on
your idea?

Yes

No
Please indicate with areas of expertise are most relevant to you :

Business development

Project management

Finance and funding

Communications

Human resources

Other

Technical/specialist assistance
Other (please specify)

8. Start a conversation
We are seeking Young Champions who can inspire others to take action for the environment. We
need you to prove to us that you can engage and influence a community. You can do this by starting
a publicly accessible conversation about the environment on your preferred social media platform
and using the #YoungChamps hashtag. The subject of the conversation might be your big idea, a
prescient conservation challenge, an emerging sustainable technology, or whatever other
environmental issue you deem worthy of discussion.
1 Your preferred social media
platform (e.g. Facebook,
Weibo or Twitter)
2 Your social media username

4|Page
3 Link to the publicly accessible
post initiating conversation
4 Alternatively, if you don’t use
social media, you can share a
weblink to photographic or
written evidence (e.g. a
report) of an environmental
discussion, workshop or
campaign that you have
organized.

Sincerely,

(Name.....)

5|Page