US Participant Application
Project COMMON BOND 2015
July 25 - August 3, 2015
Bryn Mawr College, Pennsylvania
Application Due:
April 1, 2015
Participant Information:
Please use the space provided under each section; click on the grey space and begin typing.
First Name:
Age at PCB:
Middle Initial:
Date of Birth:
(mm/dd/yyyy)
Last Name:
Gender:
Street Address:
City:
State:
E-Mail Address:
Home Phone Number:
Religion:
Additional Languages:
T-Shirt Size (S, M, L, XL, 2XL):
Zip Code:
Cell Phone Number:
Additional Language Proficiency Level (beginner, intermediate, fluent)
Speaking:
Reading:
Writing:
Parent/Guardian Information
First Name:
Middle Initial:
Last Name:
E-Mail Address:
Home Phone:
Cell Phone:
1
Health Information
Dietary Restrictions:
Allergies:
Are you currently receiving any
therapeutic support?
Disabilities:
Have you received any in the past?
Questionnaire:
Every participant in Project COMMON BOND has experienced the loss of a family member to
an act of terrorism.
How did you learn about Project COMMON BOND?
Have you attended Project COMMON BOND in the past? If so, in what years?
Which family member did you lose?
When?
Age at Loss?
Which event caused this loss?
Where did the event occur?
2
For first time participants only:
Participant Questions:
Due to the increasing interest in Project COMMON BOND and to insure the quality of the
program, a selection process has been instituted. To help us, please answer the following 3
questions. At least two paragraphs should be devoted to each question. This is NOT an
academic assignment, and there are no right answers.
1. – Why would you like to come to Project COMMON BOND, and what do you hope to learn
from the experience?
2. – What qualities and/or skills do you bring to a program like Project COMMON BOND?
3. – Please tell us about an experience you have had in your life that has changed or shaped who
you are as a person.
Recommendation:
Please submit a Letter of Recommendation from one of the following sources: Teacher,
Therapist, Coach, Family friend, Guidance Counselor, or Local Official.
3
For all Participants:
Parent
As a parent of your child, you know them better than anyone else.
In our experience, we have found it to be most helpful to get your observations of your child.
Naturally everyone wants to represent their child in the best possible light, and we want to hear
your praise, but we are also interested in any areas of challenge or difficulty.
Your unique view of your child will help us to support them in their participation in Project
COMMON BOND. We would be most grateful for your input on the following questions.
1 – What are the qualities that best describe your child’s personality?
2- How does your child participate within a group?
We understand that all of us are on a continuum of introverted/extroverted. It is helpful for us to
know more about where your child is most comfortable.
3 – How would you describe your child’s strengths?
4 – What are your child’s areas of vulnerability?
For example. Is it hard for your child to initiate with other’s; does your child shy away from new
challenges; what does your child do when conflict arises? These are just possible categories.
5 – Have there been any recent changes, transitions, within your family that we should be aware
of?
6 – Anything additional that would be useful for us to know about your child, so that we can
provide support throughout the week?
Thank you for taking the time to share your thoughts with us.
We look forward to getting to know your child and for the positive experience we hope he/she
will have at Project Common Bond.
4
Project COMMON BOND Leadership Track
We are pleased to announce a new program within Project Common Bond. Participants who
come to Project Common Bond all have had an experience of a personal loss due to terrorism.
We know that you all share an understanding of what it means to rise above this trauma. The
Leadership Program is a space designed for you to shape meaning and growth out of this
common bond, and translate it into positive action.
This track is only available for participants who are 19 years and older. Those who attend as
Leaders in Training this year are welcome and encouraged to continue their leadership
development for their remaining years as Project COMMON BOND participants.
LEADERSHIP PROGRAM:







A multi-cultural group to explore the meaning and role of Leadership – who are the
“Leaders” in our everyday lives?
The group will meet daily in a facilitated group throughout PCB week.
Participate in group discussion and share experiences designed to learn and develop skills
connected with Leadership.
Define areas for Leadership within your specific home community.
Participants will take on leadership roles throughout the week:
Example – Be a Big Brother/Sister to a new participant.
Create a presentation on Leadership for the PCB community.
All Participants in this program will receive a Certificate of Leadership Training.
REQUIREMENTS:


Participants MUST be 19 years or older to apply.
Participation in the Leadership Program is NOT a guarantee for becoming a Group
Leader. (Group Leader’s MUST be 21 years old to apply for that position.)
TO APPLY:
If you are interested in applying for the Leadership Program, please submit a written
statement about your particular interest in Leadership training, and provide an example of
an individual leader who has influenced you.
Use the space below for your answer; answers should be at least two paragraphs.
5
Application and Program Fee Deadline & Instructions:
Application Deadline:
Early Submission: March 1, 2015 ………………$1,750.00
Regular Submission: April 1, 2015 ..……………. $2,050.00
We have limited resources for extreme hardship. Project COMMON BOND 2015 is contingent
on adequate funding. Please contact Program Director, Danielle Coon, at
Danielle@tuesdayschildren.org if you would like to discuss this.
Please return application by e-mail to Program Coordinator, Deirdre Dolan at:
Deirdre@tuesdayschildren.org. Please indicate “Project COMMON BOND 2015 Participant
Application” on the subject line.
Please mail program fees to:
Tuesday’s Children
ATTN: Danielle Coon
10 Rockefeller Plaza, Suite 1007
New York, NY 10020
If you have any questions, please contact Program Coordinator, Deirdre Dolan at:
Deirdre@tuesdayschildren.org.
Once your application has been approved, you will be notified and sent an additional packet of required
paperwork.
We look forward to seeing you at Project COMMON BOND!
Signature:
Date:
6