Welcome. We're glad you're considering
joining a Birthright Unplugged trip!


DEADLINE EXTENDED!!

To apply to the Birthright Unplugged trip BDS & Activist Campaign Workshop, please fill out the application and e-mail it to us at: info@birthrightunplugged.org. Applications are due Friday May 8, 2010. Please complete your application fully as acceptance to the program is competitive.

After receiving your completed application, we will be in touch with you. We have found that most participants questions can be answered by the FAQ page of our website. If after reading it, please feel free to send us your questions via e-mail. After acceptance on a Birthright Unplugged trip, you will be expected to mail in ($750-$850 Unplugged Trip and Workshop) and a signed Participant Agreement.

Download forms (forms are also available below):

2010 Unplugged Program Application in MS Word format

2010 Unplugged Program Application as a PDF

2010 Participant Agreement as a PDF

. . .

 

Birthright Unplugged 2010 Application

Please fill out this application and e-mail it to us at info@birthrightunplugged.org.

Personal Information:

Full name:

Date of birth:

Organization or Institutional Affiliation(s):

Position:

Street address:

City/State/ZIP:

Country of residence:

Citizenship(s):

Telephone number(s):

E-mail address:

More about you:
For the following questions, there is no minimum or maximum length requirement.  We recommend no more than a paragraph for most questions, but we encourage you to answer thoroughly as your acceptance to the trip is largely dependent on this application.

1.  How did you learn about Birthright Unplugged?

2. Have you had experiences with cultures different than your own?  Please describe any difficulties with this experience and/or lessons learned.

3. Have you ever been to Israel/Palestine, the West Bank, or Gaza?  If so, please briefly describe the circumstances of your visit(s) and tell us a little about your experience.

4. Very briefly, what do you see as the root causes of the conflict in Israel/Palestine?

5.  What is your understanding of and relationship to Zionism?

6. Why do you want to participate in a Birthright Unplugged trip?

7. What are some questions you have about Israel/Palestine that you hope to learn more about?

8. We will be guests in Palestinian people’s homes and communities and witness to their lives.  What do you know of the cultural norms of Palestinians?

9. What does it mean to you that we will be a mostly N. American group traveling in occupied Palestinian communities?

10. Do you have any health concerns or conditions that might affect your participation in a Birthright Unplugged trip?  Are you taking any medication regularly?  If you join a Birthright Unplugged trip, we will need the name of any medication(s) you will be taking or anticipate needing during our trip.  This information will be kept strictly confidential.

11.  Do you have any dietary restrictions i.e. vegetarian, vegan, allergies etc…?

12.  Where will you be right before the program begins, and should you be accepted, can you commit to participating all of the days of the program?

13. Have you read the Participant Agreement? Should you be accepted, are you prepared to sign the Agreement and mail in the non-refundable sliding scale contribution of $750-$850?

About your work:

1. Please describe any social justice and/or organizing work you are or have been involved in other than Palestine-related work and your role(s) etc...

2. Please describe your Palestine justice campaign work you are involved in and your role(s) etc...

3. If you have been involved in BDS work of any kind, please explain how:
___ Considered starting a campaign
___ Presently doing research on starting a campaign
___ Launched a campaign in the past 3 years
___ Launched and dropped a campaign due to obstacles
___Other
Please elaborate:

4.  Should you be accepted to participate in a Birthright Unplugged trip, what are your goals for  the trip and after the trip, and how do you anticipate using what you learn?  Please be very specific.

5. Which communities and/or institutions are the focus of your BDS and justice work? (please name all that apply):
Religious institution: __________________________________________________
University: _________________________________________________________
City council/municipality: ______________________________________________
Union: _____________________________________________________________
Consumer products (to promote or boycott): _______________________________
Local store (department, grocery, etc): ___________________________________
Other:

6. What partners have you engaged or are you are planning to engage in BDS and justice campaign work?

7. What obstacles do you anticipate encountering or have you already encountered?

8. What skills, tools, relationships, and other resources do you want to cultivate in order to be better equipped to undertake BDS and justice campaign work?

 

9. Should you be accepted to the program, you will be asked to make short presentations and to contribute to group conversations about the potential of BDS movements and the specific strategies you are considering for use in your communities.  What research and pre-trip preparation do you plan to conduct in order to make your campaign planning time at the institute as productive as possible and to contribute to the peer learning atmosphere we hope to encourage at the institute?

 

10. Are you able to make a two year commitment to supporting BDS and justice campaign work following your participation in Birthright Unplugged?  Please describe what is in place in your life in order to ensure that you are able to maintain this commitment.

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Birthright Unplugged 2010 Participant Agreement

Personal Information:

 

Full name (as it appears in your passport):

Preferred name:

Date of birth:

Gender(s):

Street address:

City/State/ZIP:

Telephone number(s):

E-mail address:

Citizenship(s):

Passport number & date of issue:

Emergency contact, relationship to you:

Emergency contact, phone, email:

1. While in Palestine, I will make an effort to observe and respect local cultural norms.  These norms include abstaining from alcohol*, refraining from engaging in behavior that may be seen as flirtatious with people I meet during the trip, and adhering to the dress code as outlined on the Birthright Unplugged FAQ page (http://www.birthrightunplugged.org/unplugged/faq).  After the trip, I will observe these norms if and when I return to communities introduced to me on the trip. I understand that my presence in these communities may continue to be associated with Birthright Unplugged, and that my violations of cultural norms may jeopardize the organization’s relationships, reputation, and work. 
*During a free night which is not followed by a homestay, it may be possible to drink alcohol discreetly.

2. I agree to be sensitive to dynamics that may arise within the Birthright Unplugged group as well as with the individuals and groups with whom we meet, and I agree to listen more than I speak.

3. I accept that my behavior at all times during the trip must be nonviolent, both physically and verbally, and consistent with local laws.

4. I will sign, scan, and email this agreement to info@birthrightuplugged.org within one week of my acceptance.

5. I will send a $750-$850 contribution to Birthright Unplugged upon acceptance, and I understand that this goes toward most program costs, including travel, meals, speakers, translators, admission fees, and lodging from the time I arrive in Jerusalem until the end of the program, with the exception of a few meals (est $5-$15/meal) and car rides ($2-$4 ea), and any liquor, gifts, and internet café use usage or personal items I may purchase.  In addition, I understand that airfare and transportation to and from airport is est. $10 - $15 each way and is not included in the program fees.

6. I agree to participate in the program in full except in case of illness or emergency and in consultation with trip leaders.

7. I understand that the organizers of the trip have full authority to remove me from the program if my presence is deemed harmful to the group or to the Palestinians with whom we visit.

8. I authorize Birthright Unplugged to record and edit video and photos taken during the trip in which my likeness, image, and/or voice may appear. Birthright Unplugged may use and authorize others to use all or parts of this video and/or photography. Birthright Unplugged shall own all rights, title, interest, and copyright to the video and or photography, whose use and disposal shall remain the sole discretion of Birthright Unplugged to determine. I understand that the use of any images taken by individuals on the trip may require the written authorization of those appearing in them for public use.

9. I hereby release Birthright Unplugged from any liability in the event of any damage or injury to my person or my property before, during, or after the Birthright Unplugged trip.

Health Related Information:

Do you have health problems or conditions that might affect your participation in a Birthright Unplugged trip (this information will be kept strictly confidential)?

Are you taking any medication regularly?      If you join a Birthright Unplugged trip, we will need the name of any medication(s) you will be taking or anticipate needing during our trip.

Do you have any dietary restrictions or preferences i.e. vegetarian, vegan, allergies etc…?

Participant’s signature & date: ___________________________________________________________

Parent or guardian’s signature & date (required if under 18): ____________________________________

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