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[http://israel.usembassy.gov](http://israel.usembassy.gov/)

[What is the MEPI Youth Summer Leadership Institute?]{.underline}

-   It is a fully-funded six-week intensive leadership training program
    in the U.S. for undergraduate students.

-   Participants develop leadership and collective problem-solving
    skills, exploring U.S. history and culture to expand their
    leadership skills and knowledge.

-   The Institute consists of hands-on leadership training workshops,
    academic sessions, site visits, community service projects, optional
    homestays and other opportunities for interaction with Americans
    peers, and other cultural activities.

-   The program runs from July 5 to August 19, 2007. It includes a
    two-day orientation in Washington D.C., a four-week academic
    residency program at a U.S. university or college, and a two-week
    educational study tour to other regions of the U.S.

-   Students also participate in an alumni conference held in the Middle
    East or North Africa in early 2008.

-   The program is fully funded, including international airfare, travel
    within the United States, accommodation, food, and program fees.

[Can I apply for the MEPI Youth Summer Leadership
Institute?]{.underline}

Yes you can if...

-   You are an Arab citizen of Israel, living in Israel, and attending
    college or university in Israel

-   You are currently in your **first year** or **second year** of
    college or university (excluding orientation year)

-   You will be 18 to 21 years old as of July 1, 2007

-   You are proficient in English

-   You are mature, responsible, independent, open-minded, tolerant, and
    thoughtful

-   You have a strong interest in learning about the United States

[How do I apply?]{.underline}

Applications...

-   Can be downloaded from http://israel.usembassy.gov/

-   Applications are due at the Public Affairs Office of the U.S.
    Embassy Tel Aviv, 1 Ben Yehuda Street, Migdalor Building, 8^th^
    floor, Tel Aviv by **January 31, 2007**

-   Can be hand-delivered to Manal Haddad or Elena Mischel at the Public
    Affairs Office,

-   1 Ben Yehuda Street, Migdalor Building, 8^th^ Floor, Tel Aviv

-   or submitted electronically to :

-   <HaddadMM@state.gov> and <MischelEX@state.gov>

-   All applications must by typed

Selected applicants...

-   Will be invited for an interview on **February 12, 2007**

-   For the interview must bring:

-   A printed and signed copy of the application

-   Copies of academic transcripts

-   Copy of a one-year valid passport

**For more information contact Manal Haddad and/or Elena Mischel**

**at the Public Affairs Office**

**Tel.: 03-510-3823.**

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**YOUR NAME**

***(as it appears on your passport)** Family First Middle*

**CONTACT INFORMATION**

Permanent mailing address: CPR #:

: Mobile telephone:

: Home telephone:

: E-mail address:

## 

## PERSONAL INFORMATION

Gender: Male Female Date of Birth:

*Day / Month / Year*

Country of Citizenship: Country of Birth:

Country of Residence: City of Birth:

## ACADEMIC INFORMATION

School Name: Year in School:

Major Field: College or University -- First Year

*(e.g. economics, science, business, English, etc.) (excluding
orientation year)*

Minor Field: College or University -- Second Year

*(if applicable) (excluding orientation year)*

**REFERENCES**

Please provide the name of a teacher or professor who has agreed to
serve as a reference for your application.

Reference Name: Title:

Email address: Mobile Phone:

**YOUR NAME**

***(as it appears on your passport)** Family First Middle*

## EDUCATIONAL BACKGROUND

Please provide complete information about all the educational
institutions that you have attended or are attending for your secondary
and undergraduate education.

+-----------------+----------------+------+------+------------+------+
| **Institution   | **Institution  | **D  |      | **Major /  | **G  |
| Name**          | Location**     | ates |      | Minor      | PA** |
|                 |                | At   |      | Fields**   |      |
|                 | **(City,       | tend |      |            |      |
|                 | Country)**     | ed** |      |            |      |
|                 |                |      |      |            |      |
|                 |                | **M  |      |            |      |
|                 |                | M/YY |      |            |      |
|                 |                | --   |      |            |      |
|                 |                | MM/  |      |            |      |
|                 |                | YY** |      |            |      |
+-----------------+----------------+------+------+------------+------+
| Coll            |                | F    | To:  |            |      |
| ege/University: |                | rom: |      |            |      |
+-----------------+----------------+------+------+------------+------+
| Secondary       |                | F    | To:  |            |      |
| School:         |                | rom: |      |            |      |
+-----------------+----------------+------+------+------------+------+

Please explain any gaps in your education:

**HONORS/AWARDS**

Please list any special honors or awards you have received:

## ENGLISH PROFICIENCY

[Speaking]{.underline}: Excellent [Reading]{.underline}: Excellent
[Writing]{.underline}: Excellent

Good Good Good

Fair Fair Fair

**YOUR NAME**

***(as it appears on your passport)** Family First Middle*

**WORK EXPERIENCE** *(if applicable)*

Please start with your most recent position. You may include volunteer
activities and internships.

+----------------------+-------------------------------+-------+-------+
| **Name of Employer   | **Your Job Title and          | **    |       |
| and**                | Responsibilities**            | Dates |       |
|                      |                               | of    |       |
| **Location**         |                               | Em    |       |
|                      |                               | ploym |       |
|                      |                               | ent** |       |
|                      |                               |       |       |
|                      |                               | **    |       |
|                      |                               | MM/YY |       |
|                      |                               | --    |       |
|                      |                               | MM    |       |
|                      |                               | /YY** |       |
+----------------------+-------------------------------+-------+-------+
|                      |                               | From: | To:   |
+----------------------+-------------------------------+-------+-------+
|                      |                               | From: | To:   |
+----------------------+-------------------------------+-------+-------+

**YOUR NAME**

***(as it appears on your passport)** Family First Middle*

**EXTRACURRICULAR ACTIVITIES** *(if applicable)*

Please describe any activities, clubs, or organizations in which you
participate. You may include volunteer and sports activities.

+------------------+-----------------------------------+-------+-------+
| **Name of        | **Describe the activity**         | **    |       |
| Activity**       |                                   | Dates |       |
|                  | **and your role**                 | of    |       |
|                  |                                   | Inv   |       |
|                  |                                   | olvem |       |
|                  |                                   | ent** |       |
|                  |                                   |       |       |
|                  |                                   | **    |       |
|                  |                                   | MM/YY |       |
|                  |                                   | --    |       |
|                  |                                   | MM    |       |
|                  |                                   | /YY** |       |
+------------------+-----------------------------------+-------+-------+
|                  |                                   | From: | To:   |
+------------------+-----------------------------------+-------+-------+
|                  |                                   | From: | To:   |
+------------------+-----------------------------------+-------+-------+
|                  |                                   | From: | To:   |
+------------------+-----------------------------------+-------+-------+
|                  |                                   | From: | To:   |
+------------------+-----------------------------------+-------+-------+

**MEMBERSHIPS** *(if applicable)*

Please list your membership in any other organizations:

**SPECIAL INTERESTS** *(if applicable)*

Please describe any hobbies or special interests:

**YOUR NAME**

***(as it appears on your passport)** Family First Middle*

**UNITED STATES EXPERIENCE**

Please describe any previous travel or study in the United States. If
you have not traveled to the United States, indicate "none."

+----------+----------+----------------------------------+-----------+
| **Travel |          | **Travel Purpose**               | **US      |
| Dates**  |          |                                  | Gov       |
|          |          | **(e.g. vacation, school,        | ernment** |
| **MM/YY  |          | etc.)**                          |           |
| --       |          |                                  | *         |
| MM/YY**  |          |                                  | *Program? |
|          |          |                                  | Y/N**     |
+----------+----------+----------------------------------+-----------+
| From:    | To:      |                                  |           |
+----------+----------+----------------------------------+-----------+
| From:    | To:      |                                  |           |
+----------+----------+----------------------------------+-----------+

**YOUR NAME**

***(as it appears on your passport)** Family First Middle*

+-----------------------------------------------------------------------+
| **SHORT ESSAY #1**                                                    |
|                                                                       |
| *What are your career goals? How will leadership training help to     |
| prepare you to meet these goals?*                                     |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **SHORT ESSAY #2---**                                                 |
|                                                                       |
| *Identify one political, social, or economic challenge facing your    |
| country today. What steps could be taken to solve the problem or      |
| improve the situation? What role can students play in this process?*  |
+-----------------------------------------------------------------------+

**YOUR NAME**

***(as it appears on your passport)** Family First Middle*

+-----------------------------------------------------------------------+
| **DISCLAIMER** *(all applicants)*                                     |
|                                                                       |
| The information in this application is accurate and complete. The     |
| written work in the short essays is my own and I have not been        |
| assisted by any other person. I understand that I may be required to  |
| verify information in this application by providing documentation     |
| including (but not limited to) transcripts, test scores, and writing  |
| samples. I also understand that intentionally falsifying information  |
| in this application could be grounds for disbarment from U.S.         |
| Government funded exchange programs.                                  |
|                                                                       |
| Signature:                                                            |
|                                                                       |
| Date:                                                                 |
+-----------------------------------------------------------------------+