E4 Galilee Application – Summer 2020 | The American MidEast Leadership Network

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About AMLN
E⁴ Programs
Get Involved
Contact Us

E⁴ – Galilee : Application
Summer 2020

Dates: August 1st , 2020 – August 14th , 2020
Price: $5,000

For more information, please contact Rami Nuseir:
Mobile: +1 (347) 924-9674
Email: rami@amln.org

Student Information:

Please enter your full name, as it appears on your passport.

First name:

Middle names:

Last name:

Gender: (this is required for organizing accommodations)

Date of Birth:

Home Phone Number:

Mobile Phone Number:

Email:

School Name:

Year:

Address:

Street number and name:

City:

State:

Country:

ZIP Code:

Personal Essay:

In 500-750 words, explain why you wish to participate in E4 Galilee, what you expect to take away from it, and how you envision to put these learning to use.

Please type your response in a word document and attach it here:

Passport Information:

How many passports do you have? 123

Passport 1:

Passport Number:

Passport Expiry Date:

Passport Photocopy:

Passport 2:

Passport Number:

Passport Expiry Date:

Passport Photocopy:

Passport 3:

Passport Number:

Passport Expiry Date:

Passport Photocopy:

Emergency Contacts:

Please provide at least two emergency contacts. All emergency contacts must be adults (above the age of 21). One of them must be your guardian.

Emergency Contact #1: Primary Guardian

Full name:

Mobile Number:

Relationship:

Describe relationship:

Emergency Contact #2:

Full name:

Mobile Number:

Relationship:

Describe relationship:

Emergency Contact #3: (Optional)

Full name:

Mobile Number:

Relationship:

Describe relationship:

Allergies & Special Conditions:

Drug Allergies: Do you have any drug allergies? NoYes