2021-22 Palestinian Participant Application

PARENT / LEGAL GUARDIAN INFORMATION
Name of Parent/Legal Guardian 1 *

First Name Last Name
Please select the relationship of Parent/Legal Guardian 1 *

Father Mother
Email (must be different than your own) *
example@example.com
Mobile Phone Number *
+### ##-#######
Parent / guardian email must be different than your email.
Name of Parent/Legal Guardian 2 *

First Name Last Name
Please select the relationship of Parent/Legal Guardian 2 *

Father Mother
Email *
example@example.com
Mobile Phone Number *
+### ##-#######
Parent / guardian email must be different than your email.

RELIGIOUS PRACTICES

Your answers to the following set of questions will not be used when deciding whether or not to accept your application. This information helps us learn more about you and your relationship with religion, and better support your needs as a participant if accepted.
Which religion(s) do you most identify with? *

Christianity Islam Judaism None
Religions Total
If "None of the above" is chosen, it must be the only one selected.
What is the level of your current religious observance? *

Religious Traditional Secular
If you/your family attends religious services, where?

HEALTH INFORMATION

Your answers to the following set of questions will not be used when deciding whether or not to accept your application. This information helps us better support your needs as a participant if accepted.
Are you currently diagnosed with any medical condition?

Yes No
Please describe your medical condition: *
Do you take any medication on a regular basis?

Yes No
Please list the medication(s): *

LONG-ANSWER QUESTIONS

Please answer TWO of the following questions. Your answers should be no longer than two paragraphs.

Please be ready to be completely honest when describing your opinions. We are looking for a variety of perspectives, not "what we want to hear."
If you had the opportunity to speak to your leaders, what would you want to tell them?

0/500
Essay Number 1
What is your primary source of news? What types of media do you follow and where do you get your information?

0/500
Essay Number 2
Choose a historical event related to the conflict and explain how this event has affected your life and why this event is important for people to know about and understand.

0/500
Essay Number 3
How do you think your community will react if you participate in Hands of Peace? How will this reaction affect you?

0/500
Essay Number 4
Essay Total
At least TWO questions must be answered.
Any final comments, questions, or concerns, or additional information you would like us to be aware of?
By checking "Yes" you are confirming that your parents/guardians know that you are applying to participate in Hands of Peace, and that they understand what the program is, and the responsibilities and the tuition fee/scholarship procedures involved if accepted. Any extra charges incurred due to a change in plans would be their responsibility. By checking "yes" you are also confirming that you and your parents understand that Hands of Peace requires a serious commitment to the dialogue process from the participants accepted. We may dismiss participants from Hands of Peace if our program guidelines are not respected. *

Yes, I understand and accept the statement above.
THANK YOU FOR COMPLETING THIS APPLICATION!

By submitting this form, you are granting: Hands Of Peace, 1000 Elm St, Glenview, IL, 60025 United States, http://www.handsofpeace.org/ permission to email you. You can revoke permission to mail to your email address at any time using the SafeUnsubscribe® link, found at the bottom of every email. We take your privacy seriously (to see for yourself, please read our Email Privacy Policy). Emails are serviced by Constant Contact.
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