First Name:  *

Last Name:  *

Email Address:  *

Phone number (home):  *

Phone Number (mobile)  *

University or Company or Organization with which you are affiliated:  *

Street Address of Residence:  *

Village or Town or City of Residence:  *

State or Governorate of Residence:  *

Country of Citizenship  *

Are you proficient in Arabic or English or both? (English and Arabic translation will be provided at the conferences, language skills will not be a factor in evaluation or admission.)

Have you attended any youth activities before? If so when and on what topics?  *

Are you active in any organizations (civil society politics religious journalism human rights education business etc)? If so which ones and what do you do (what is your role)?  *

Please write an essay (Arabic or English) of no longer than 500 words on the topic of why you believe it is important for young Americans and the people of the Middle East to discuss ways to improve American foreign policy toward the region.  *

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