International Participant Application
Project COMMON BOND 2014 Spain
July 20 – July 30
Participant Information:
Application Due:
March 21, 2014
First Name:
Age at PCB:
Middle Initial:
Date of Birth:
(mm/dd/yyyy)
Last Name:
Gender:
Street Address:
City:
E-Mail Address:
Home Phone Number:
Region:
T-Shirt Size (S, M, L, XL, 2XL):
Zip Code:
Country:
Cell Phone Number:
Religion:
First Language:
English Proficiency Levels: (beginner, intermediate, fluent)
Speaking:
Reading:
Writing:
Additional Language:
Additional Language Proficiency Levels (beginner, intermediate, fluent)
Speaking:
Reading:
Writing:
Additional Participant Information:
Passport #:
Passport Expiration Date:
Do you have a Skype account?
Yes
No
If Yes, what is your username?
Passport City of Origin:
*Please include a copy of passport.
Parent/Guardian Information
First Name:
Middle Initial:
Last Name:
E-Mail Address:
Home Phone:
Cell Phone:
Allergies:
Disabilities:
Health Information
Dietary Restrictions:
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Are you currently receiving any therapeutic
support?
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?
Which family member did you lose?
When?
Age at Loss?
Which specific event caused this loss?
Where did the event occur?
Which NGO, Social Service, other organization will recommend you?
Contact Name:
Contact E-Mail:
Contact Phone Number:
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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, typed on a separate sheet of paper
(see attached). 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:
For first time participants only:
Please submit a Letter of Recommendation from one of the following sources: Teacher, Therapist, Coach, Family
friend, Guidance Counselor, or Local Official.
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 also we are 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. Please
attach additional information if necessary.
1. - What do you admire most about your child?
2. - How does your child function in groups?
3. – What are your child’s strengths?
4. – Have there been any recent changes in family, school or social life that we should be aware of?
5. – Anything else that might be useful for us to know about your child?
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Name:
Participant Questions:
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.
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Application Deadline & Instructions:
DEADLINE: March 21, 2014
Please return application by e-mail to Program Manager, Aja Minor, at: Aja@tuesdayschildren.org. Please
indicate “Project COMMON BOND 2014 Participant Application” on the subject line.
If you have any questions, please contact Program Manager, Aja Minor, at Aja@tuesdayschildren.org.
Once your application has been approved, you will be notified and sent an additional packet of required
paperwork. We have limited resources for extreme hardship. Project COMMON BOND 2014 is contingent on
adequate funding.
I agree to provide my own travel arrangements to Project COMMON BOND 2014 Madrid, Spain
Signature:
Date:
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