CAIR-Houston 2020 Muslim Youth Leadership Symposium Application
First Name *
Last Name *
Gender *
Address *
City and State *
Zip Code *
Phone Number *
Email *
Parent or Guardian Name (First and Last) *
Parent or Guardian Cell Number *
Parent or Guardian Email *
Ethnicity *
Date of Birth *
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Name of the educational institution you currently attend *
Address of School
What school districts have you attended?
Is English your first language? *
Which masjid do you attend? *
Select your class standing as of Fall 2020 (if applicable)
Clear selection
Date of middle or high school graduation
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DD
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School Counselor/Teacher Name (Note: This person might be contacted as a reference.)
Counselor/Teacher Phone Number
How did you hear about MYLS (check all that apply) *
Why do you want to participate in CAIR-Houston's 2020 Muslim Youth Leadership Symposium? What do you hope to gain from this experience? (150 words max.)*
Please summarize your involvement in community organizations (faith-based and secular). For all volunteer and paid roles, please list and explain the position(s) held, date(s) in position, and hours worked per week. (150 words max.)*
What event has had a lasting impact on your life and how has it changed your view of the world and your role in it? Note: Think about a challenging obstacle you have had to overcome, or a moment of triumph that you have experienced. (500 words max.)*
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This form was created inside of Council on American-Islamic Relations-Houston.