2012 – 2013 DELEGATE APPLICATION
Deadline: October 26, 2012
Instructions:
1. Please complete all required fields within the word limit. We will only accept complete applications that
do not exceed the limit allotted to the questions.
2. Submit the application as a PDF. Make sure that the document is correctly formatted and saved as your
first name last name
Example: John Smith.pdf
3. The deadline for the application is October 26, 2012 at 11.59 PM PST (-8 GMT)
4. Please email the PDF of the application to amends-info@stanford.edu, with your name and country in
the subject line. Also list all attachments in the body of the email.
Example: John Smith, United States
5. Please save any attachments starting with your first name last name document type
For example: John Smith Transcript
6. If you have any questions, please email amends-info@stanford.edu. Due to the high volume of emails,
please allow us 2-3 days to respond to your email.
7. Please make sure to use your name as it appears on your passport
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Dear Prospective Delegate:
Thank you for your interest in the American Middle Eastern Network for Dialogue at Stanford (AMENDS).
AMENDS offers a unique opportunity to interact, collaborate, and form personal relationships with fellow
youth leaders from across the Middle East, North Africa, and the United States, while exchanging ideas and
implementing initiatives that work towards a better future.
AMENDS has three main components: networking, summit, and the AMENDS Talks. Upon selection as a
Delegate, AMENDS will facilitate multiple introductions to established leaders in your field. During the
Summit, Delegates will share their ideas, collaborate on their initiatives, and interact with world leaders in
workshops, panel discussions, and formal networking events. The conference will culminate in the AMENDS
Talks, presentations from all of the delegates on their initiatives, ideas, and experiences. These presentations
will be shared online for the world to see.
Delegates will be selected based on the level of their dedication to promoting change in the MENA region
and/or in U.S.-MENA relations. We will also heavily consider the past experiences and backgrounds of each
delegate that will enable him/her to contribute a unique perspective to the conference, in order to ensure a rich,
diverse group of delegates.
As a participant in the AMENDS conference, your lodging, food, and conference expenses will be covered.
Participants who have the financial means to contribute to their travel expenses (plane, train, etc) will be
expected to do so. If selected as a Delegate, the AMENDS Team will assess your level of need, offer a
corresponding travel subsidy, and work with you, when possible, to acquire a travel grant or scholarship from
your university or organization. However, the application process is need-blind and AMENDS hopes to
ensure that financial concerns do not prevent anyone from participating in the Summit.
Being selected as an AMENDS Delegate entails a commitment to continue giving back to your community,
country, and world. Delegates are expected to remain in touch after the conference, be representatives of
AMENDS, and continue helping others to affect positive change.
Applicants currently living outside of the United States:
In the event that you are accepted to serve as a delegate, please keep in mind that you will need a valid passport
that is valid at least six months from the time of the conference, and an American visa. We will do our best to
assist you in the visa process should you need one. In addition, English proficiency is required.
Enclosed is a four-page application form, which includes seven (7) sections. You will also need to attach:
1. Resume/CV
2. OPTIONAL: any website links, e-articles, or certificates you believe highlight your greatest
accomplishments that are properly labeled in the body.
Sincerely,
The AMENDS Team
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PERSONAL INFORMATION
1. Full Name (as it appears on your passport)
2. Preferred Name
3. Mailing
address
4. Date
of birth
7. Place
of birth
(country)
5. Age
6. Gender
8. Hometown
M
9. Citizenship(s)
10. Email address
F
11. Phone number
12. Where will you reside during the 2012-2013 academic year?
13. How did you hear about AMENDS?
ACADEMIC INFORMATION
Education (please list all
institutions attended after high
school)
Dates Attended
(month/year)
Field of Study (please
list all majors and
minors)
Grade Point Average
(please indicate overall,
e.g. X.XX/4.00)
Are you still in school? If yes, please your degree program and year
LANGUAGES SPOKEN
Language
Ability Level (advanced,
intermediate, beginner)
If Studied, Years of Collegiate Study
ENGLISH
3
ENGLISH PROFICIENCY
Please fill out section if English is not your first language. You need to contact us if you do not have proper examination
proof if English is not your first language before application submission.
Writing
Listening
Speaking
Reading
TOTAL (total score / overall)
Please highlight test taken
IELTS
TOEFL
Please highlight type of test
IBT (internet based) CBT (computer) PBT (paper)
REFERENCES
You will be notified beforehand if AMENDS wishes to contact this person. Please list two.
Name of Reference
Relationship and years of
link
Reference Email
Reference Phone
Number
TRAVEL INFORMATION
Have you ever lived in a country outside of your home country? Have you ever visited a country outside of your
home country?
Please limit your response to 80 words.
4
ESSAY QUESTIONS
A.
Describe an initiative/project you are currently working on or hope to start that relates to US/MENA relations or
social, political, economic concerns in the MENA region. Be sure to address all of the following: Goals, Action
plan, and Existing and/or needed resources.
Limit your response to 400 words.
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B.
What experiences do you have that would enable you to contribute to the AMENDS Summit? How would these
ideas and experiences translate into your AMENDS Talk?
Limit your response to 400 words.
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I attest that all information submitted within this application is complete and accurate to the best of my
knowledge. I also certify that I completed this application myself, without aid or assistance from any
other individual. I understand that submitting false or misleading information will result in my exclusion
or dismissal from the program. If selected, I agree to comply with the rules and regulations of Stanford
University and the American Middle Eastern Network for Dialogue at Stanford.
Signature________________________________________
Date__________________
In addition to the application form, please attach a resume/CV
Optional:
If you feel you have any supplementary material, including, but not limited to a web address,
press releases, newspaper articles, or electronic documents, that you would like us to be
aware of that will help give us a better picture of you, please make a note of it below and
attach it to the application. Please note that declining to submit any supplementary form will
not impact your chances for getting selected.
Supplementary materials submitted/attached:
1)
2)
3)
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