Arab Youth Leadership Summer Institute 2019: June 10th-June 14th
A program of AYO, the youth arm of the Arab Resource and Organizing Center (AROC).
For more information please visit:
www.araborganizing.org
Email address *
Background Information
First Name *
Your answer
Last Name *
Your answer
Birthdate *
Your answer
Place of Birth *
Your answer
Families' Country or Countries of Origin *
Your answer
Religious Identity
Your answer
Gender *
Your answer
School Grade Level *
Indicate what grade you will attend next year, if you are graduated, or if you are not in school
Your answer
School Name and City *
Your answer
Languages Spoken *
Your answer
What language are you most comfortable communicating in? (written and spoken) *
Your answer
What is your approximate family income? *
Are you in need of financial assistance for transportation costs from your home to the program locations? *
Contact Information
Street Address *
Your answer
City, State *
Your answer
Zip Code *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Emergency Contact Relationship *
Your answer
Physician Name (if applicable)
Your answer
Physician Phone (if applicable)
Your answer
Insurance Carrier and Policy Number (if applicable)
Your answer
Medications taken
Your answer
Allergies
Your answer
Do you have any dietary restrictions? If so, what are they? *
Your answer
School and Community Involvement Experience
What kinds of activities are you involved in through your community, school, or elsewhere? *
Your answer
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? *
Your answer
What would you like to learn or gain from participating in this institute? (List at least 3 concrete goals) *
Your answer
How do you think you could use this experience in the future? *
Your answer
photo consent *
What shirt size do you wear? *
Have you participated in AYO before? *
Do you have any conflict with the institute schedule due to summer school?
Commitment Pledge *
Submit your application!
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.

A copy of your responses will be emailed to the address you provided.
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