3506 University Street #113
Montreal, QC H3A 2A7
Tel: (514)398-6717
Fax: (514)398-7241
mmep@mcgill.ca
www.mcgill.ca/mmep
ICAN 2013 Summer Institute in the Middle East
Israel, Jordan, Palestine
Application form
Personal Information:
Name (Last, First): __________________________________________________
University: ________________________________________________
Program of Study: ___________________________________________
Degree: ____________
Year: ______________
Mailing Address (permanent): _______________________________________
_______________________________________
_______________________________________
Email Address: ___________________________________________________
Phone Number: ___________________________________________________
Travel Document Information
Citizenship(s): ____________________________________________________
Passport number: __________________________________________________
Expiry date: ______________________________________________________
Country Preference:
I understand that the Summer Institute program consists of placements in two of the three
countries involved. My preferred countries to be placed are: (please rank in order 1st, 2nd, 3rd)
Israel ____________
Jordan ___________
Palestine _________
Language Capacity:
First language: _____________________
Other languages (check one in each row):
Fluent
(written /
spoken)
Proficient
conversational
Intermediate
level spoken
Some
knowledge
None
Hebrew
Arabic
Other:
Other:
Academic credit:
Students can arrange to receive academic credit for field placements, internships, coursework, or
independent study/tutorial courses. How many academic credits do you hope to receive through
participation in the Summer Institute? (please check)
9 credits ______
6 credits ______
3 credits ______
0 credits ______
Narrative response:
1. Please explain (250 words or less) why you want to participate in the ICAN Summer
Institute.
2. Please list the experience and skills that you feel you will put to use in your placement. (If
you do not have proficiency in Hebrew and/or Arabic consider this in your response) (500
words or less).
3. Questions and/or comments:
Confirmation:
I, _______________________________, confirm that I will be available for the duration of the Summer
Institute, from May 12, 2013 through July 20, 2013.
__________________________________________
Applicant Name and Signature
_________________________
Date
PLEASE SUBMIT APPLICATION FORM (Scanned signed copy) AND YOUR CV, VIA E-MAIL, TO
mmep@mcgill.ca
BY DECEMBER 17, 2012 (first round), OR JANUARY 28, 2012 (second round).
Any questions can be directed to:
Jodi Michaels, ICAN Director of Communications, jhm.mmep@mcgill.ca
Website link: www.mcgill.ca/mmep/summer-institute