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2018 ARAB YOUTH SUMMER LEADERSHIP INSTITUTE FOR YOUTH EMPOWERMENT & COMMUNITY ORGANIZING
Presented by: The Arab Resource and Organizing Center (AROC) and Arab Youth Organization (AYO)

For more information please visit:

Email address *
Personal Information:
First Name
Last Name
Birthdate
Place of Birth
Families' Country or Countries of Origin
Religious Identity
Gender
School Grade Level
Indicate what grade you will attend next year, if you are graduated, or if you are not in school
School Name and City
Languages Spoken
What language are you most comfortable communicating in? (written and spoken)
What is your approximate family income?
Are you in need of financial assistance for transporation costs from your home to the program locations?
Contact Information:
Street Address
City, State
Zip Code
Home Phone
Cell Phone
Email Address
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Phone
Physician Name (if applicable)
Physician Phone (if applicable)
Insurance Carrier and Policy Number (if applicable)
Medications taken
Allergies
School and Community Involvement Experience
What kinds of activities are you involved in through your community, school, or elsewhere?
Do you experience challenges in your school or community because of your religious or racial background? If yes, how do you manage to face these challenges?
What would you like to learn or gain from participating in this institute? (List at least 3 concrete goals)
How do you think you could use this experience in the future?
photo consent *
Commitment Pledge *
Thank you for your application!

Depending on the quantity of applicants, youth may be asked to participate in an interview process in order for the selection committee to make its final decision.
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