認定NPO法人 聖地のこどもを支える会
APPLICATION FORM 2020 LET’S BUILD A PEACE BRIDGE IN JAPAN!* This application form and the other attached documents you will submit to the NGO “Helping Children in the Holy Land” are confidential and will be reviewed only by the committee of selection of the NGO.Please see the p. 4 of the Guidelines for Applicants.APPLICANT’S INFORMATION Date: 2020Family NameFrist NameMiddle NameNationalityDate of BirthPlace of BirthReligionGenderM / FHome AddressIndicate your complete address.ContactPhone No.Home MobileEmailSkypeOccupationContact in Case of EmergencyNameMr. / Mrs. / Ms. Relationship with youPhone No.Home MobilePassport No.Date of IssueDate of ExpirationID No.Date of IssueDate of ExpirationEDUCATIONAL BACKGROUNDHigh School/Univ.City/StateGradeMajorYearsDegreeLANGUAGESLanguagesNativeExcellentGoodFairPoorEnglishHebrewArabicOthersWORK / VOLUNTEER EXPERIENCESPositionName of OrganizationPeriodTasksSKILLS / BACKGROUND of MUSIC or PERFORMANCEPlease indicate if you have any special skills/experiences of singing or dancing. Answer:Special skills:Background of music (singing, or instruments) and performing art (dance etc.): QUESTIONSHow did you know and what did you hear about the “LET’S BUILD A PEACE BRIDGE IN JAPAN” Project?Answer:This project focuses on interaction among Israeli, Palestinian and Japanese youth. What are your motivations and why do you think you are the right person to participate in this project? Elaborate.Answer:Describe yourself, your personality, your relationship with your family and with the people around you? Answer: What is your idea about the way to live in peace in your community of in your country? What is your dream for the future, etc. Elaborate. Answer: As an Israeli/Palestinian youngster, what is your perspective concerning the ongoing conflict and its resolution? Elaborate.Answer: How can you become a peace builder and peace messenger in the future? Please describe your wish, or your dream or concrete planning, or determination, if you have. Elaborate.Answer: ABOUT YOUR HEALTHQuestionsYesNo1. Do you have a chronic or recurring illness/condition?2. Have you had any illness or infectious disease recently?3. Do you have any allergy? (medicines, insects, foods, etc.)4. Do you have diabetes or asthma?5. Do you have any dietary restrictions? (medical, religious, etc.)* Respecting our diversity and community life, the Project will take into consideration your religious and allergic dietary restrictions, but not your personal preferences. In addition, the Project is not capable of providing vegan or strictly kosher meals.Q: If you answered “yes“ to any of the above questions, please explain. _______________________________________________________Q: Blood type: _____/RH____Q: Do you smoke? YES / NOQ: Do you have tatoo? YES / NO ABOUT EXTENTION OF YOUR STAY IN JAPANIt is possible to extend your stay in Japan after the Project. About the conditions, please see the page 4 of the “Guidelines of the Project”.Q: Do you want to extend your stay in Japan? YES / NO Q: If yes, please tell us the return date your want. _______________ABOUT THE “FRIENDSHIP MEETINGS” IN JERUSALEM Once selected, we invite you to one of the “Friendship Meetings” with Israeli, Palestinian and Japanese youngsters. No participation fees.Jerusalem Date: 14th March, 2020 (Sat)14:00 ~ 17:00Place: Notre Dame of Jerusalem CenterJaffaDate: 20th March, 2020 (Fri)13:00 ~ 16:00Place: St. Peter’s Church, Old JaffaDo you join this program? YES / NO If yes, which one? Or both?JERUSALEM / JAFFAABOUT OUR COOPERATION IN THE FUTUREYou are requested to continue to be part of Peace Bridge activities after the project.* Participate in exchange programs, meetings, activities after going back to your country.* Participate in exchange programs, meetings and activities for Japanese study tour group in March 2021.We may ask you to host Japanese student(s) at your home upon their visit.Is your home able to host students (accommodation and meals)? YES / NOIf you answered YES to the above questions, how many guests can you host at your home, and which gender?Answer: Signature: _______________________________Date: _______________________________Please attach following documents.Application formYour photograph (good and decent)Copy of your passport and IDIf you have musical (singing) or performing art (dance) background, you are kindly requested to attach to your application form a video of your performance (2 or 3 minutes maximum).If not, no need. ................
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