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1. Please confirm your email address

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2. Are you applying for a scholarship to attend the Conference in person in Kigali or for a virtual scholarship?

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3. Prefix

4. First name

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5. Middle name

6. Family name/ Last name/ Surname

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7. Is your preferred name the same as your legal name?

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8. Legal first name

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9. Legal middle name

10. Legal family name/ last name/ surname

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11.1 Phone Country Code (+xxx)

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11.2 Phone number

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12. WhatsApp number - if different from main phone number (+xxx xxxxxxxxxx)

13. Street address

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14. City

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15. Zip/postal code

16. Country of Residence (current residence)

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17. Country issuing passport

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18. Age

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19. Region of citizenship

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20. Passport number (if applying for in-person and do not have a Rwandan passport)

21. Gender

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22. If you chose "Other", please specify

23. Preferred Pronouns

24. If you chose "Other", please specify

25. Currently the Conference will provide simultaneous interpretation in English, French, Spanish, and International Sign Language. While we cannot commit at this time to provide other options; please state your preferred language of communication.

26. Women Deliver acknowledges that certain communities are disproportionately affected by discrimination. Do you identify with any of the following?

27. If you chose "Other", please specify

28. Have you attended a Women Deliver Conference?

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29. Women Deliver is committed to hosting a diverse, inclusive, and accessible conference for all, including persons with disabilities. Closed captioning and International Sign Language interpretation will be available throughout the programming. Do you have any reasonable accommodation requests, including traveling with an assistant or companion, to facilitate your participation? If so, please specify:

30. Have you been awarded a scholarship to a Women Deliver Conference before?

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31. Are you only able to attend Women Deliver with financial assistance?

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32. Have you also applied to organize a Concurrent session?

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33. Have you been invited to speak at an event during the on-site Conference in Kigali?

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34. If yes, what is the event and what organization has invited you?

35. Organization/ Company/ Agency

36. Job title

37. Type of Organization

38. If you chose "Other", please specify

39. Are you currently a student? If so, what level of schooling will you be in in 2023?

40. If you chose "Other", please specify

41. Area of Expertise

42. If you chose "Other", please specify

43. What skills, knowledge, or experiences do you hope to gain by attending WD2023? (150 words)

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44. Can you provide 2-3 specific examples of the activities you have/ are currently carrying out to make a difference on issues affecting girls and women? (e.g., professional, academic, or volunteer projects) (150 words)

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45. How do you plan to meaningfully engage with your community and/or government after attending the Conference? How will you apply what you gain from attending WD2023 to your work? (150 words)

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46. Would you be interested in speaking at one of the Conference sessions

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47. If yes, do you agree to Women Deliver sharing your contact information with Women Deliver Conference organizers and/or partners looking to identify speakers for their programming?

48. By checking this box, I acknowledge that, if I receive a Women Deliver 2023 scholarship, I am willing and able to participate fully in the Women Deliver 2023 Conference; share knowledge gained at the conference through a medium of my choice by the end of 2023; and adhere to the Conference Code of Conduct.

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