APPLICATION FORM

The Majid AlSadi Changing Lives Programme

Amman, Jordan

Monday 7th of September – Friday 18th of September 2015

Eligibility for the programme (please tick the boxes to confirm you meet the minimum requirements to apply):

I confirm that I am a full time student at Coventry University (as of 1st January 2015)
I confirm that I can (and will) participate fully in the programme from 7th September – 18th September 2015
I confirm that I have a valid passport to enter Jordan AND that my passport is valid for a minimum period of six months from the date of entry into Jordan
I confirm that I am willing to share a twin room with another ‘Changing Lives’ scholar (of the same sex)

ABOUT YOU:

Title / Forename(s) / Surname
Student ID / Course / Faculty
(AD, BES, EC or HLS) / Year of Study (as of 1st January 2015)
Home
Address
Town / Nationality
Postcode / Mobile number / Other phone number
Email / Date of Birth
Are you proficient in any other languages than English? If so, please state / Have you visited the Middle East before? If so, where and when did you visit?
Hobbies and Interests
If you had £500 which charity would you choose to support and why?
What thing have you done that has given you the greatest personal satisfaction?
If you had to describe yourself as an animal, what would you be and why?
Do you have any experience with groups of vulnerable persons? If so, please give details.
Tell me how you would typically resolve conflicts?
What would you like to get out of this programme?
Why should we select you to take part in the programme ahead of all the other applicants?
Reference: Please write the name of one academic referee, including their office address and contact telephone number.
(We may contact them during the application process)

Please ensure that you submit this form either electronically via email or by delivering your form by hand to the Alan Berry Reception by Monday 3rd August 2015, 4PM.

Should you have any queries, please contact Brendan StJohn, the Project Manager on 024 7688 8589 or via email