Application for Hope Fund Undergraduate Scholarship Program
Personal Information
YOUR NAME ______________________________
____________________________
Last
____________________
First
Middle
CONTACT INFORMATION
Physical address in your home country:
Home telephone:
Fax number:
E-mail address:
Sex:
Male
Female
Date of Birth:
Place:
Month/Day/Year
City
Country
Country of permanent legal residence: ________________________ Country of citizenship:
List all countries where citizenship is held:
Which of the following travel documents do you carry?
Palestinian I.D. Card
ID Number: _______________________
Jerusalemite Laissez-Passer
ID Number: _______________________
Jordan
ID Number: _______________________
Lebanon
ID Number: _______________________
Egypt
ID Number: _______________________
Palestinian Authority
ID Number: _______________________
Other________________
ID Number: _______________________
Do you hold an American passport or green card?
Yes
No
Do you hold an Israeli passport?
Yes
No
Are you a registered refugee?
Yes
No
Are you a registered Palestinian refugee?
No
Yes: Name of camp:
Have you applied or are you considering applying to schools on your own?
Yes
No
If you answered “yes”, list all the schools that you have applied to or are considering applying to:
Name of School
Date Applied/Will Apply
School Contact Person
Family & Financial Background
Your parents are:
Married
Divorced
Separated
Widowed
Father’s occupation: ________________________
Degree Holding:_________________________________________________
Mother Occupation: ________________________
Degree Holding: _________________________________________________
Family Financial Assessment
During the last 12 months, how much household income did your family receive from the following sources?
(Please indicate yearly amount for each category in U.S. dollars)
Mother’s (or Guardian’s) annual income
$______________
Father’s (or Guardian’s) annual income
$______________
Your work
$______________
Family business
$______________
Family real estate holdings
$______________
Pension
$______________
Any other sources of family income
$______________
Other (explain)
$______________
TOTAL YEARLY INCOME
$______________
Does your family own property or family home?
Yes
No
Sibling Information
Number of Brothers: ___________________
Name of Brother/Sister
Number of Sisters: ___________________
Age
Current/Previous Occupation
Are there any other members of your immediate family either presently enrolled in university education or will be enrolled in
university education at the same time as you?
Yes No
Are any of your relatives living in the United States or holding a green card or U.S. citizenship?
Father
Mother
Brother
Sister
Aunt (mother’s or father’s sister)
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Uncle (mother’s or father’s brother)
Cousin
Income Verification: Translation Document
This document is to provide English translation for income or expense verifications that have been provided in Arabic and attached.
This document needs to be completed by the student and then signed off by someone from the Hope Fund or AMIDEAST verifying
the accuracy of the translation.
Name of Applicant:____________________________________
Date: _______________________________________________
Income or expense verification for:
Father
Name: _______________________
Mother
Name: _______________________
Siblings tuition expenses
Name: _______________________
Household in general
Form of verification attached:
Monthly Pay Slip
Letter from Employer
Utility bill. If so, what type: ________________
Tuition Statement from school. If so, name of school:_______________________
Other_____________________________________________________________
Amount listed in document – local currency: __________________________________________________
Amount listed in document -- USD:___________________________________________________________
Time period covered: _____________________________________________________________________
If a pay slip, what is the gross amount and currency: _____________________________________________
What is the net amount listed and currency: ____________________________________________________
What expenses are taken out: _______________________________________________________________
Name of Hope Fund or AMIDEAST staff verifying accuracy of translation: __________________________
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Secondary School Information
School name (in English): ___________________________________________________________________
School address: ____________________________________________________________________________
Type of school:
Private
Current grade level:
11th
Public
UNRWA
12th
Extracurricular, Volunteer Activities & Honors
a)
Have you ever participated in any of the following AMIDEAST sponsored programs?
YES
ACCESS
Lincoln
Other______________________________________
b) List all extracurricular activities and all hobbies in which you have participated. Please state if you have received
any awards, or have any outstanding achievements in these activities.
Name and Description of Activity
Name of Award
Month/Year Started
Reason for Receiving Award
Month/Year Ended
Date of Award
Language Proficiency
Native language(s):
Number of years of English study: _____________________ Where studied:
Knowledge of foreign languages, including English (Rate your abilities as Excellent, Good, or Fair):
Language Name
Reading Ability
Writing Ability
English
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Speaking Ability
Standardized Test Scores
Please indicate your test scores below:
Test Name
Date taken or to be taken
Score
ITP
TOEFL
SLEP
SAT I
SAT II (Subject)
OTHER
Physical Challenges/Disabilities
Do you have any physical disabilities?
Yes
No
Please describe any physical disabilities that you have: ____________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
If you answered “yes,” what type of accommodation or equipment does your physical disability require and which you currently
use? Examples include a wheelchair, hearing aids, etc.
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SHORT ESSAYS
1. Describe your family’s current economic situation.
2. Discuss why you feel that you should be awarded this scholarship.
3. Describe your academic objectives and goals in terms of your field of study and the reasons why you wish to
pursue them.
4. Describe the career you plan to pursue after completion of study in the United States.
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5. You are asking the Hope Fund and AMIDEAST to spend time and financial resources to help you secure
placement and financial aid at a U.S. college or university. This is a $200,000 to $240,000 4-year investment. How
do you plan to balance the demands of your Tawjihi year with applying to US colleges? How do you intend to
make sure you complete all materials on time? The Hope Fund will disqualify any applicant who does not fully
commit to the application process and requirements.
6. The Hope Fund works almost exclusively with liberal arts colleges. Explain your understanding of the liberal
arts educational system. What do you like about it? How does it suit you? If you are unwilling to attend a liberal
arts college, please state so now and explain why.
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7. Have you discussed the liberal arts system with your parents? Do they understand and accept that you will not
specialize in a specific field right away?
8. Explain how you see yourself, AMIDEAST and the Hope Fund working together over the next year during
your application and placement process. What is your role and what are your key responsibilities in this
partnership?
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Eligibility Checklist
Competition for the program is open to anyone who meets the following requirements. Anyone who does not meet the eligibility
requirements listed below should NOT apply.
Verify your eligibility by checking each box to indicate that YOU ARE eligible:
Come from a socio economically disadvantaged background.
Currently in the 11 or 12th grade and have a grade point average of at least 90% or a ranking within the
top ten percent of the class.
Fluent in spoken and written English.
Not a U.S. citizen or green card holder.
Sign here to indicate that you have read and understood all of the above eligibility requirements. Evidence of dishonesty or
withholding of relevant information in the application or dealings with program representatives at any time will result in dismissal
from the program.
Signature of Applicant: ________________________________ Date:_____________________
Supporting Document Checklist
Please complete all sections of the application form for which you have relevant information. All applicants must submit a
completed application and the following supporting documents by hand to AMIDEAST by the deadline.
Tick the items in the checklist below to indicate the information/documents provided:
9th grade Grades/Report Card
10th grade Grades/Report Card
11th grade Grades/Report Card (only for current 12 th graders)
Grades reported in Excel worksheet
Essay questions in English
Copy of the data/photo pages of your passport
Completed, signed application form
Applications not fully completed or missing supporting documents will not be accepted or considered for
review.
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Student Consent—To be completed by the applicant
I am responsible for all parts of my application.
I am responsible for understanding each step of the application process.
I am responsible for meeting all deadlines for the application process.
I am responsible for responding to all emails and information requested in a timely manner.
I understand all writing submitted in the application must be mine and mine alone.
I pledge to behave respectfully and honestly in all steps of this process.
I pledge to cooperate with all requests from the Hope Fund and inform them of any changes immediately.
I understand that I will be immediately disqualified for missing ANY deadline.
I understand that just applying for the scholarship program does not guarantee that I will be awarded a scholarship.
I agree that I am required to abide by all AMIDEAST and the Hope Fund policies pertaining to the attendance, behavior,
punctuality and assignments and may be disqualified from the program if I do not adhere to all of these policies.
I hereby confirm that all information contained in this application is true and accurate. I also understand that I may be
removed from the program if it comes to the attention of either AMIDEAST or the Hope Fund that any information provided
in this application is not true or accurate.
Student’s signature: ________________________________________________Date:__________________________________
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Parental Consent—To be completed by a parent
My son/daughter has my permission to apply for the Hope Fund Scholarship administered by AMIDEAST. I agree
that my son/daughter is required to abide by all AMIDEAST and Hope Fund policies pertaining to attendance,
behavior, punctuality and assignments. My child may be disqualified from the program if he/she does not adhere to
these policies.
I hereby confirm that all information contained in this application is true and accurate and that I understand that
my son/daughter may be removed from the program if it comes to the attention of either the Hope Fund or
AMIDEAST that any information provided in this application is not true or accurate.
That being said:
1. I hereby confirm that all information contained in this application is true and accurate and that I
understand that my son/daughter may be removed from the program if it comes to the attention of
AMIDEAST or Hope Fund that any information provided in this application is not true or accurate.
2. I have no objection to my child traveling alone. I understand that if my son/daughter receives a scholarship
to study in the United States, he/she will attend school alone and without any family escort.
3. I understand that if I withdraw my son/daughter from the application process for any reason that I could
control, I shall be required to provide financial compensation to the Hope Fund and AMIDEAST for any
effort and any reasonable costs which they incurred to support my child’s application up to the day that the
application is officially withdrawn in writing.
4. My signature is evidence of my approval of these conditions.
Parent/Guardian’s signature: ____________________________ Date:
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