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APPLICATION

MOROCCO

2012 MIDDLE EAST PARTBERSHIP INITIATIVE (MEPI)

FOR STUDENT LEADERS PROGRAM

Instructions

1. Complete the application below directly in this document. Incomplete applicationswill not be considered.

2. Submit your application by e-mail to rabatyouth@state.govby Tuesday, January 31,2012. No late applications will be accepted.

3. Submit a copy of the photo page of passport.

4. Submit evidence of high academic achievement.

5. For more information, please contact the Public Affairs Section atrabatyouth@state.govor call 0537-66-81-87.

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A. Last (family) name as it appears on passport:

B. First name as it appears on passport:

C. Middle name as it appears on passport (if applicable):

D. Date of birth (month/day/year):

E. City of birth:

F. Country of birth:

G. Country of residence:

H. Country of citizenship:

I. Gender:

J. Full address (include apartment number street, city, state, and postal zone):

K. Primary telephone number (home/mobile/work/etc):

L. Current email address:

M. Medical, physical, dietary or other personal considerations (please note, no physicalexamination is required to participate in the program):

N. Name of your School and / or university:

O. Your field of study (if applicable):

P. Describe your civic engagement, leadership and/or work experience, extracurricularactivities, and academic honors; including positions and titles (if applicable):

Q. Education, academic and professional training (Please include fields of specialization and

any degrees earned(if applicable). Please also note any special honors or awards received):

R. Active memberships (in clubs, associations, etc):

S. Special interests:

T. Details of any Previous travel and study or research experience outside of Morocco(Please include dates):

U. Evidence of English language ability (e.g., personal interview, test score, etc.):

V. Candidate's Personal Statement (no more than one page)(Please describe how your participation would contribute to your academic achievement and career

plans in the future (for example: enhanced knowledge/expertise, new curriculum ideas, career

advancement, publications, networking opportunities). How might you share your experience withothers at home both in your institution and community after your program? What else should weknow about you?)

W. Respond, in 1,000 words or less, to each of the following questions:

Name one leader living today that you admire and explain why. What qualities doeshe or she have that makes him or her an effective leader?

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How will your participation in the MEPI Student Leaders Program benefit you andothers?