International Participant Application
Project COMMON BOND 2015
July 25 - August 3
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: / Middle Initial: / Last Name:Age at PCB: / Date of Birth: (mm/dd/yyyy) / Gender: / T-Shirt Size (S, M, L, XL, 2XL):
Street Address: / City: / Region: / Zip Code: / Country:
E-Mail Address: / Home Phone Number:
/ 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: / 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:
Health Information
Dietary Restrictions: / Allergies: / Disabilities: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?Have you attended Project COMMON BOND in the past? If so, which years?
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:
For first time participants only:
Participant Questions:
Please provide at least two paragraphs to answer the following question.
1. – Why would you like to come to Project COMMON BOND, and what do you hope to learn from the experience?
Recommendation:
Please submit a Letter of Recommendation from one of the following sources: Teacher, Therapist, Coach, Family friend, Guidance Counselor, or Local Official.
For all Participants:
Parent
As a parent of your child, you know them better than anyone else. Please answer these questions so that we can learn a little bit more about them before the program.
1. - What do you admire most about your child? What are your child’s strengths? What does your child find challenging?
2. - How does your child function in groups?
4. – Have there been any recent changes in family, school or social life that we should be aware of?
5 - Is there any information that you feel would be helpful to share with the group leader and facilitators working directly with your child?
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 one paragraph.
Application Deadline & Instructions:
DEADLINE: April 1, 2015
Please return application by e-mail to Program Coordinator, Deirdre Dolan at: . Please indicate “Project COMMON BOND 2015 Participant Application” on the subject line.
Please note: Coming from a first time participating country your Project COMMON BOND 2015 program fees and travel arrangements to Bryn Mawr College, Pennsylvania are being waived.
If you have any questions, please contact Program Coordinator, Deirdre Dolan at: .
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:
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