Survey: U.S. Citizens denied entry into Israel
U.S. citizens who are Arab or Muslim have experienced significant difficulties in entering or exiting Israel or the West Bank. As such, the U.S. Department of State has asked ADC to provide a list of U.S. citizens who have been denied entry into Israel in the last year or so.  Participating in this survey will help the Bureau of Consular Affairs to identify trends that can be addressed.  
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First Name
Last Name
Phone Number
Email
Are you a U.S. Citizen?
Clear selection
Have you experienced significant difficulties in entering or exiting Israel in the past two years?
Clear selection
Were you detained and questioned?
Clear selection
If so, for how long were you detained and questioned?
Clear selection
Have you been denied entry into Israel in the past two years?
Clear selection
At which port of entry were you denied entry?
Clear selection
Did the Israeli authorities confiscate your U.S. passport?  
Clear selection
What is your ethnicity/race?
Clear selection
What is your religious affiliation?
Clear selection
Are you politically active?
Clear selection
If so, please describe your political activity as it relates to Israel/Palestine and civil rights.
(Example: "Participate in Pro-Palestine and BlackLivesMatter movement protests", "Member of pro-Palestine advocacy groups" (ADC/AAI/US campaign to end the Occupation/Jewish Voice for Peace etc.), "Actively post pro-Palestine views on social media" (twitter/facebook), "Promote BDS movement", etc.)  
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