EmailMe Form - Muslim Youth Leadership Symposium

Name *

First Last

Email *

Primary # *

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Gender *

Date of Birth *

MM / DD / YYYY

Students must be high school age

Home Address (Mailing Excellence of Leadership Award) *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

EDUCATION

Name of School *

Class *

OTHER INFORMATION

T-Shirt Size *

List any food allergies

Describe any disabilities requiring attention

Emergency Contact Information

Name *

First Last

Relationship *

Home Phone *

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Cell Phone *

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Student Certification *

I certify that the information submitted in this application is accurate to the best of my knowledge, and that I am the sole author of the essays submitted.

SHORT ANSWER-250 WORD LIMIT EACH

(Optional)

How does your faith define you as a student or young professional? How do you reconcile non-faith situations or scenarios with your faith identity? Be specific.