Apply Now | NEXUS

2019 NEXUS Asia Summit Application

We invite you to share as much information about yourself as possible in the application below, so we can curate a meaningful Summit and experience for you. Thank you!

ONLY QUESTIONS WITH A RED ASTERISK REQURE RESPONSES

You are a candidate for the:

First Name

Last Name

Phone

Have you ever participated in a NEUXS event, salon, delegation etc? If so, which ones?

Have you attended a past NEXUS Summit? If so, what new ideas/activities have you pursued, inspired by your NEXUS experience ? How have you connected/collaborated with other members?

Your Biography - Don't be shy, tell us how amazing you are!

May we share your biography with other Summit delegates?

YesNo

Sharing Permissions - For Summit materials, I give permission to share:

How did you learn about NEXUS? (Indicate the person's name, if applicable.)

Your Company/Organization

Your Job Title

Your Birth Date (MM/DD/YYYY)

*Preference is given to those under the age of 45, though applications of people of all ages are considered.

Gender

FemaleMaleOther

References - Who gets to vouch for how amazing you are? (A minimum of one reference is required)

Their Name

Their Phone

Their Email

Their Title, Company/Organization name. What else should we know?

Your Primary Mailing Address

Street

City

State / Province

Country

Zip/Postal Code

Secondary City

Secondary State / Province

Secondary Country

Let's Get Social - Please share your social media profiles.

Facebook Profile URL (Share for an invite to our private NEXUS Facebook Group.)

LinkedIn URL

Twitter @Handle

Instagram Profile

Website (Personal or company)

Blog/Other Social Media

How do you Characterize Yourself? (Obviously you are committed to social change, but please select up to 3)

Press and hold Ctrl to select multiple (Command on Mac)

Interests - What issue areas are you interested in learning more about and accelerating change in? (Please select no more than 3)

Press and hold Ctrl to select multiple (Command on Mac)

Are you a member of one or more of the following networks?

Press and hold Ctrl to select multiple (Command on Mac)

Your Passions - What are your social impact passions & how are you working to accelerate change in these fields?

Family Engagement - What social impact areas and passions are your family engaged in now or have been engaged with historically?

Your Goals - What do you hope to gain from your participation in the Summit?

What Are You Excited to Share/Contribute to the Community? - How will you add value via unique perspectives, experiences, ideas, or opportunities?

Family Business - Do you and/or your family have a business? If so, please share the name, industry, and what your role is, if any.

Personal/Family Philanthropy - What philanthropic donations do you, your family or your family business make? (Please describe what kinds of non-profit organizations and initiatives you support and what impact you've helped create that you are most proud of?)

Personal/Family Impact Investing - If you, your family or family business make impact investments, please describe social-impact companies/funds invested in and any impact investing strategies employed. (Please differentiate between investments made by you, your family/your family business.)

Your Giving Process - In line with the questions above, please describe the decision-making process for you and/or your family's giving and investing. Are you a decision maker?

Board Affiliations - Do you have a titled role serving as an advisor, trustee, or board member to a grant-making foundation or non-profit? If so, please explain.

Nominations

Applications with nominations listed receive special attention in the review process.

Please share names and email addresses of one or more family members, friends or colleagues that you believe would add value or find value in joining a NEXUS Summit. You can also "Pay it Forward" and sponsor the registration cost of your nominee(s), if they are accepted.

First name

Last name

Company / Organization

Why do you nominate this person? Why are they a good fit for NEXUS?

How would you characterize the nominee?

Should they be accepted, I wish to underwrite a full or partial scholarship for this nominee to attend the Summit.

Accelerate Impact Together with the NEXUS Community

We believe that mobilizing the collective power of NEXUS members can affect real change. NEXUS is engaging select financial institutions around better aligning money and values with impact. Are you in interested in collaborating with NEXUS members in advancing social change through your investments? If YES, please answer the below:

1. Which banks, wealth managers, brokerage accounts, family offices, or donor advised funds, is your capital managed by?

Press and hold Ctrl to select multiple (Command on Mac)

1a. Other

1b. Family Office

2. How much (in an amount) of your own personal or your family’s collective assets do you have a decision making role in (foundation, real estate, trusts, brokerage accounts, investments etc)? How much (in an amount) do you expect to have a decision making role over 5 years from now?

2a. Amount Now

2b. Amount In 5 Years

(Any public disclosures would contain aggregate numbers and would not identify members individually except with prior written consent).

Host a Fellow NEXUS Member - Make a difference & a friend. If you live in a host city, do you wish to host a social entrepreneur overnight during the summit?

Dietary Preferences - NEXUS is proud to live our values & aims to host plant-based summits. Please select any dietary preferences you have, if applicable.

Anything Else? - Phew, you've made it this far... Just in case, please share anything else you feel we should know about your personally or professionally? We look forward to seeing you at the Summit!

Your Photo:

Financial Subsidies - Limited financial subsidies may be available through July 1st to support a discounted registration fee. Subsidies cannot support travel or lodging. If interested please email SimoneM@nexusglobal.org for a subsidy form. Subsidies can only be considered for those who first complete this application form.

NEXUS COMMUNITY CODE OF CONDUCT - Please check the four boxes below to confirm that you have read & agree to uphold each of them.

1. Non-Solicitation: Including but not limited to business/fundraising efforts & promotions.

I have read this & Agree to it.

2. Safe Space: Free from verbal, online, physical or sexual harassment and assault. Free from discrimination on the basis of nationality, race, class, religion, age, ability, sexual orientation, perceived gender identity or expression.

I have read this & Agree to it.

3. Drugs & Alcohol: Official summit events are drug-free & alcohol is to be consumed responsibly.

I have read this & Agree to it.

4. Violations: Violations should be reported to redflag@nexusglobal.org and can be grounds for dismissal. As a private community, NEXUS reserves the right to rescind summit acceptance or community membership at any time for violations of the Code of Conduct or for other reasons.

I have read this & Agree to it.

***IF YOU RECEIVE AN ERROR COMPLETING THIS FORM Pleases email info@nexusglobal.org with specifics of the error for help

Contact Information

2019 NEXUS Asia Summit Application

COMMUNITY

STAY UP TO DATE

CONTACT