Project Interchange
An institute of the American Jewish Committee
Seminar in Israel for California Student Leaders
December 27, 2010 to January 3, 2011
APPLICATION
Please email, fax, or mail your completed application to the attention of Allie Tenenbaum at Project Interchange, , fax: 202-331-7702, mail: 1156 15th Street, N.W., Suite 1201, Washington, DC, 20005.
Please also include a copy of your resume
Applications are due by November 5, 2010
1) Full Name: ______
2) College/University: ______
Expected Graduation Date (mm/yr): ______
University: ____ Public ____Private
Size of Student Body (undergraduate): ____
Major(s): ______Minor: ______
GPA: ______
3) Current Home Address:
4) Home Phone: ______E-mail Address: ______
Cell Phone: ______
5) Permanent/Parents' Address:
6) Organization in which you hold a leadership position (if you hold a leadership position in more than one organization, please convey that):
Organization Name: ______
Number of members: ______
Please describe the mission of your organization:
Your position: ______
Period you will hold this position: ______
Expected position for 2011-2012 year: ______
8) Advisor’s Name and Daytime Phone Number:______
May we contact him/her? Yes_____ No ______(check one)
9) Have you ever visited Israel before? Yes_____ No ______(check one)
If so, please describe the nature and dates of your trip:
(10-12) If not included in your resume, please list (use additional paper if necessary):
10) Past leadership positions and other extracurricular involvements (include dates):
11) Recent internships and employment (include dates):
12) Awards or honors received:
Please provide one paragraph answers to the following questions (use additional paper if necessary):
13) Briefly define your career goals.
14) Explain why you are interested in participating in this program and what you think you will gain from the experience.
15) Describe how you view your leadership role(s) within your organization(s):
16) Please provide two references. We may contact your references to verify the information you have provided above.
Reference name: ______Relationship: ______
Phone: ______E-mail: ______
Reference name: ______Relationship: ______
Phone: ______E-mail: ______
PLEASE BE SURE TO INCLUDE A COPY OF YOUR RESUME
I hereby affirm that, to the best of my knowledge, all information I provided in this application is true and correct.
Signature______Date______