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Application Form for Leadership Award Certificate

Name: Chicago Open University
Address: 19 Holly Cove LN Dover, Kent Delaware, DE, 19901, US
Telephone: +1(585)-316-1905
Price range: 4500$

Personal Information

Upload Your Photo

Full Name(As Per Certificate)

Date of Birth

Age

Mobile Number

State

Country

Zip Code

Email Address

Facebook URL

Linkedin URL

Address

Mother Tongue

Marital Status

Single Married

Father's Name

Languages Known

Qualification Information

Qualification	Name of School / College	Year of Completion	Subjects (Place "," after Subject)
SSC (10th)
HSC (12th)
Graduation
Post Graduation
Other

Document Checklist

1.Please provide a short autobiographical summary (maximum 3,000 words) highlighting your leadership journey. Describe how you have demonstrated vision, integrity, and influence in your field or organization. Include key milestones where your leadership led to meaningful outcomes—such as team growth, strategic transformation, institutional development, innovation, or societal impact. Reflect on how your leadership style, decisions, and actions have inspired others and contributed to excellence in your domain. This summary will be a critical component in the evaluation for the Leadership Excellence Award.

Words: 0 / 3000

2. Please attach the following documents in a single PDF file:
a). Curriculum Vitae (CV)

b). Recent Passport-Size Photographs

c). Recommendation Letters (if applicable)

d). News articles / Media coverage (if any)

e). A Copy of a Valid identification document (Passport, Voter ID , Aadhar ID or any other Government Issued National ID)

3. Work related certificate/ Achievement/ Experience need to upload.

4. Reference Contacts

Relation 1

Name

Relation

Contact Number

Occupation

Relation 2

Name

Relation

Contact Number

Occupation

Declaration

SECTION G: Declaration

I hereby declare that the information provided in this application is true and correct to the best of my knowledge. I understand that submission does not guarantee the conferment of the Honorary Doctorate Award (Honoris Causa) and that the institution reserves the full right to approve or reject the application based on its internal review process.

I also grant full permission to the university to use my name, photograph, biography and any related articles or materials for institutional archives, publications, digital records and promotional purposes.

Date of Declaration

Upload Signature

Note: It is the responsibility of the person(s) completing this form to provide supporting information on the nomination to enable the Honoris Causa Award Committee to make a decision.

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