APPLICATION FOR PARTICIPATION Please fill everything using RED color Name: Gender: Passport Number: Nationality: Date

of Birth: Academic Year: University: Committee: Position: Regional Position "If you have": How many National Assemblies have you attended? Have you ever attended Eastern Mediterranean Meeting (EMR) meetings? If yes how many? How many General Assemblies have you attended? Are you an Executive Board member, National Officer, Support Division Coordinator, National Project Coordinator or local officer in IFMSA Palestine? "If yes tell us" • • YES NO

Are you organizing any sessions? Are you doing any presentations? "If yes tell us" • • YES : NO

List briefly the activities you organized or participated in IFMSA Palestine after April 2010 and till November 2011:

List briefly the activities you organized or participated in IFMSA Palestine before April 2010:

List 3 fields of medical sciences that you are interested in doing research in e.g. Mental Health, Microbiology, and Immuno-Genetics …etc:

List briefly your goals for attending the exchange program:

Describe briefly how you will use the experience you get there to help IFMSA-PS and Al-Quds school of medicine in the future:

To which of the following registration assistance from IFMSA you apply for fund? • • Delegate registration I will pay my registration myself

To which of the following TAF (Travel Assistance Fund) from IFMSA do you apply? • • • Full Ticket Half a Ticket I 'll Pay the ticket myself

If you don't get assistance fund from IFMSA-PS, do you still would like to participate in the exchange program on your own?

• •

YES NO

Note: As for the questions written in pink, it is not to examine your composition skills, so please we need to see specific defined objectives, exact points explained clearly, not whole paragraphs using synonyms, and lots of impressing adjectives! The idea behind asking about your experience in IFMSA is not to reward you by attending this meeting, but to get a hint that you are capable of achieving the goals you mention. What matters really here is what IFMSA-PS can benefit from your participation in the meeting "of course personal benefit is one of our main goals.

Please if you have any questions, don't hesitate to ask us!!!!!!!! We'll be more than happy to answer you!

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