Movement of Youth: J.U.S.T Global Fellowship Application
Witness for Peace Southeast (Nicaragua)
July 16th-30th

ADARE Soccer Camp (St. Vincent & the Grenadines)
July 22nd-31st

Application deadline: APRIL 1, 2016

http://movementofyouth.org/index.php/programs-services-movement-of-youth/j-u-s-t-global-fellowship

I. Personal Information
Name
Malaika Pettigrew
Your answer
09/18/1953
Your answer
Female
3517 Appling Way, Durham, NC 27703
Your answer
919 9734341
Your answer
Your answer
Passport Number (Include expiration date)
Your answer
High School (Include class of ____)
Your answer
II. Health Information
Negative answers to the following questions will not necessarily prevent you from participating in the J.U.S.T. Global

Fellowship. Your response will help us in assessing your special needs and allow us to take measure that would reduce

the risks of serious health matters during the course of the delegation. Please note that Movement of Youth is not

responsible for health issues that may occur during the fellowship.

General Health
List any dietary concerns (e.g. vegetarian, vegan)
Your answer
List allergies, disabilities, diabetes, heart conditions, and other health problems
Your answer
Do you have a history of drug and/or alcohol abuse? If so, please explain. This does not necessarily eliminate you from the fellowship.
Your answer
Have you been hospitalized for an emotional or mental illness within the last year? If so, please explain
Your answer
Are you currently under a physician’s care or receiving prescribed medication? If so, please explain.
Your answer
III. Personal Reference & Emergency Contact
Please provide a reference -- chose an adult that can speak of your character. (Name & Telephone)
Your answer
Please provide an emergency contact – this person will need to be given emergency contact information before you leave for the fellowship. (Name/relationship/telephone)
Your answer
IV. Experience
Have you traveled to Latin America or the Caribbean?
If yes, briefly describe your travel experience.
Your answer
What is your Spanish language ability? (For Nicaragua applicants)
Describe your experience with human rights, social justice, environmental, or other organizations that are committed to social change.
Your answer
Describe your experience working with young people (your peers or youth younger than yourself).
Your answer
Values and Commitment Essays – Please answer questions thoroughly on a separate sheet of paper. Submit to fellowships@movementofyouth.org
1. J.U.S.T. Global Fellowship explores social justice on a global level. What do you believe is the most pressing social

justice issue today and why?

2. How do you plan to be a contributing member during J.U.S.T Global Fellowship?

3. What do you hope to gain from participating in J.U.S.T. Global Fellowship?

4. If you could teach youth in another country or culture, what would be the topic and key message(s) you would convey.

I attest that all information submitted is true.
Applicant Electronic Signature & Date
Your answer
(NOTE: The above is not a waiver of liability. Delegates and parents [if delegate is under 18] will need to complete a waiver of liability form before departure.)
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