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MY NYC Application form
Email address *
Name *
First and last name
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Email *
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Phone number *
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Date of Birth mm/dd/yyyy *
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Name of School *
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What days/ times after school are you available? *
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Why you are interested in (Muslim Youth NYC) MY NYC and what do you hope to gain from this experience? ​ ​ *
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​What community issue(s) are most important to you? Explain your interest:
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Describe and explain a situation in which you acted in a leadership capacity. *
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Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you. *
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Name a person who has had a significant influence on you and describe that influence. *
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In what ways do you expect your experiences and personalities to contribute positively to the program? *
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If there is any additional information or references you’d like to provide, please use this space below.
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