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BIRZEIT UNIVERSITY The MA Program in Democracy and Human Rights Application form Dear applicant, Please fill out  this application form, make a print out, and then submit it electronically by pushing the "submit" button in the end of this application. A hard copy of the completed application form, along with the supporting documents named below, should  also be signed and sent  to the following address: The PAS Office Birzeit University, P.O. Box 14, Birzeit, Palestine   1. Picture 2. Academic records (official transcripts, certified  copies of matriculating documents) 3. Two recommendation letters (may be e-mailed on condition that the referee's name and/or institution appear in the sender identification) 4. CV or resume 5. Photocopy of your passport Please also send us (through registered mail): 1. Application fee - US$50. (Traveler’s checks need to be signed and countersigned) 2. Housing fee - US$50 (if  you require help in finding accommodation.)   Personal Information First Name     Middle Name    Last Name   Sex: Male Female Place of Birth:     Date of Birth:             Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     Month 1 2 3 4 5 6 7 8 9 10 11 12     Year 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 Citizenship (please list all, if more than one):     Marital status:     Passport number:     Have you ever served in the military? Yes No If yes in which country?     Addresses Contemporary Mailing Address Give address where mail regarding this application will always reach you. (You do not need to repeat address if your permanent address is the same.) In care of: Name  (Example: Mr. and Mrs. John R. Doe, Jr.)  Street Address/Apt. No. City      Telephone: Country code    Area code     Number  Fax:   Country code  Area code     Number   E-mail Address:  Permanent address in Country of Residence: Street Address/apt. no. (if applicable) City      Telephone: Country code    Area code    Number  Fax:     Country code      Area code    Number   E-mail Address:  List all colleges/universities attended  Name of Institution Dates Attended Field of Study Degree Name of College mon/yr to mon/yr Name of College mon/yr to mon/yr Name of College mon/yr to mon/yr Work Experience relevant to Democracy and Human Rights  (please indicate whether voluntary or paid work) Names of Most Recent Employers Years Employed Position Held Phone Number What are your professional or vocational plans after completion of study at Birzeit University (breifly)? For which term is admission requested? Academic year 2001/2002 (deadline for application is: May 15, 2001) Academic year 2002/2003 (deadline for application is: May 15, 2002) Do you require help in finding accommodation?  Yes No If yes, please state in the box to the left of each option an order of preference [1, 2, or 3] Student dormitories (This is limited space, for women only; but it may be available for men in during the Summer only) rented room in apartment with Palestinian students: A) single room B) shared room rented room in apartment with other internationals: A) single room B) shared room Languages other than Arabic: excellent good weak excellent good weak excellent good weak List References (two required who will write recommendation letters for you)  (Please indicate the address, occupation, and capacity in which they have known you) Name Organization Occupation Statement of Purpose: Please write a short essay (300 words, approximately) to explain the nature of your interest in the study of Democracy and Human Rights, and the reason for your choice of Birzeit University) The following part of the application is for non-native speakers of Arabic only: To help us determine your general level of Arabic in advance, please answer the following questions. Have you studied Arabic before? Yes No If you studied Modern Standard/Classical Arabic: What Institution/country/mode of instruction? Books/materials used: Number of years: Number of hours per week:   Have you studied Colloquial Arabic?  Yes No If Yes, which dialect? What institution/country/mode of instruction? Books/materials used: Number of years: Number of hours per week:   Would you be interested in taking additional Arabic Language courses at Birzeit University? Yes No I certify that this residence status information is correct by filling in my name (if independent) or my parent's name (if not independent) and the current date. Name:  Date:               Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     Month 1 2 3 4 5 6 7 8 9 10 11 12     Year 2000 2001 2002 Please note: Acceptable forms of payment for tuition and fees should be in US dollars, and ONLY in Cashier's check, bank draft, or check . Personal checks, postal money orders or credit cards are NOT accepted. ATM machines are available, and many of them accept Visa and Mastercard. It must noted, however, that they are not always reliable. Please review all fields for completeness and accuracy before submitting your application.  Remember to make a print out before submitting. To submit your application press this button: