Online Application Form

 

If you are interested in applying for the 2010 summer session, are between the ages of 15 and 17
and live in Israel or Palestine, You can either:

• Click on the following link, fill out the application, scan it, and send it to Debbie Nathan
  at: deb@artsbridgeinstitute.org, or fax to: (001) 781-592-7431.

OR:


• Fill out the application form below. All fields marked * are required and MUST be filled out before
  submitting your application.
  
  IMPORTANT: Please write out the answers to your essay questions on a separate piece of paper
  first so that they are not lost if there is a problem with the application.

You will also need to include two letters of reference from adults in your community who are not related to you.
These could be school teachers, religious leaders, youth workers from organizations that you are involved in.

Please email the letters of reference to: deb@artsbridgeinstitute.org along with the referee's contact information.

 

STUDENT APPLICATION FORM

Summer Program (July 18th - August 09th, 2010)

*Last Name:		Middle Initial:		*First Name:
*Date of Birth:		*Place of Birth:		*Citizenship:
Passport:		Country of Issue:		Expiration Date:

*Do you have a passport valid for 6 months after the program ends:

Select Validity Yes No

*Gender:

Select Gender Male Female

*Name of School:

*Current Grade:

What school and community activities are you involved in?

School:

Community:

Please name two references from community organizations (e.g youth club, religious institution, community center, school etc.)

*Reference 1:

*Reference 2:

You must include written letters of recommendation from the above 2 references with your application.

OPTIONAL INFORMATION (Complete any with which you identify)

Ethnicity(ies):

Religion(s):

PERMANENT ADDRESS

*Street:		*City:
*Country:		*Telephone:		Mobile:
*Primary Email:		Secondary Email:

MAILING ADDRESS (If different)

Street:		City:
Province:		Country:

PARENT/GUARDIAN #1	PARENT/GUARDIAN #2
Title Mr. Ms. Mrs. Other *Full Name: *Address: *Home Telephone:  Business Telephone:  Mobile Telephone: *Email: *Signature:	Title Mr. Ms. Mrs. Other  Full Name:  Address:  Home Telephone:  Business Telephone:  Mobile Telephone:  Email:  Signature:

*ESSAY QUESTIONS

Please answer all questions and write your answers in English. We realize that English is not
your native language and you will not be judged on the quality of your writing skills. However,
we would like to know that you are able to express yourself in English as this will be the pri-
mary language of the Artsbridge summer program. Please use a separate piece of paper to
have more space for your answers.

1. Write a short autobiography that includes a description of your family as well as important events and
people in your life that have helped shape who you are. (1 page)



2. Tell us why you want to participate in Artsbridge and how you expect to benefit from your experience.



3. How do you expect to incorporate your Artsbridge experience into your life when you return home?



4. What are your artistic skills and creative interests? (examples: drawing, music, dance, sculpture, painting,
carpentry, writing, poetry, etc) What kind of art are you interested in learning more about?



5. What else would you like us to know about you?

Please fill out this application before March 15th 2010

Artsbridge, Inc.
Attn: Deborah Nathan
P.O. Box 113
Swampscott, MA 01907
USA

For further enquiries please email: deb@artsbridgeinstitue.org , or fax: +1-781-592-7431