Abraham's Vision - 2008-2009 UNITY PROGRAM APPLICATION -

Eligibility Checklist

Applicants must meet all of the following requirements:

1. Self-identify as Muslim and between the ages of 16-18 yrs.
OR
Self-identify as Jewish and between the ages of 16-18 yrs.

2. Will be enrolled in and attending class for the entire academic year of 2008-2009.

3. Must be able throughout the academic school year to:

Attend classes once a week.
Participate in four Interschool Meetings and two field trips during the school year.
Submit monthly written reflections.

I hereby acknowledge that I have read and understood the above-mentioned eligibility requirements and hereby attest to meeting them without exception.

Part I. Personal Information

Last Name:

First Name:

Middle Name:

Date of Birth (mm/dd/yyyy):

Place of Birth (city/country):

How do you identify yourself in terms of gender:

How do you identify yourself ethnically and/or religiously, please explain:

Languages Spoken (only include languages you are fluent in):

Part II. Contact Information

E-Mail Address:

Phone Number (Mobile):

Phone Number (Land-Line):

Mailing Address:

Permanent Address (IF DIFFERENT FROM MAILING ADDRESS):

Emergency Contact No. 1

Name:

Relationship to Applicant:

Address:

Phone Number:

Secondary Phone Number:

Email Address(es):

Part III. Academic Information

School/Community College:

City, State:

Will you be enrolled as a full-time student at this same school during the 2008-09 academic year?

Yes No

note: if your answer to this question is anything other than “Yes” you must contact us at houda_abadi@abrahamsvision.org.

Current grade level in high-school (i.e. Sophomore, Junior, Senior):
YOU MUST CURRENTLY BE IN AT LEAST 10th grade

Current GPA:

Academic Awards/Honors:

Have you ever been expelled, suspended, dismissed or had any disciplinary action taken against you by an educational institution?

Yes No

If yes, please explain in detail:

Part IV. Short Answers

1. List all after school activities including extracurricular school based activities, volunteer work and work experience:

2. Why do you want to participate in Unity Program? Why would you be a good candidate for the program? What can you contribute?

3. What intentional encounters, if any, have you had with people whose religious beliefs differ from your own? Have you participated in interfaith or intercultural programs? What about intentional encounters with those from different ethnic groups?

If you are a Jew, how do you identify yourself?

If you are a Muslim how do you identify yourself?

To select multiple items from the lists above, hold down the
Ctrl key (Command key on Mac) while selecting items.

Part V. Essay Question

Please answer the following in 300-400 words.

What do you think are the three most important issues facing Muslim and Jewish relations is the US?

When done with online application click "SUBMIT APPLICATION" button below.