Welcome. We're glad you're considering
joining a Birthright Unplugged trip!
To apply to Birthright Unplugged, please fill out the application and e-mail it to us at:
info@birthrightunplugged.org.
Please complete your application fully as acceptance to
the program is competitive. To apply for the BDS + I institute, please complete BOTH the regular Unplugged and the BDS + I applications.
After receiving your completed application, we will be
in touch with you. We may request a phone conversation if we
feel like we need more information from you, and you are always welcome
to request a phone
conversation with one of us if you have further questions that cannot
be answered by the FAQ page of our website
or via e-mail communication with us. After acceptance on a Birthright
Unplugged trip, you will be expected to mail in ($700-$850 Unplugged and $250-$350 BDS Institute) and a signed Participant Agreement.
Download forms (forms are also available below):
Unplugged Application in MS Word format
BDS + I Institute Application in MS Word format
Participant Agreement as a PDF
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Birthright Unplugged Application
Please fill out this application and e-mail it to us at info@birthrightunplugged.org.
Personal Information:
Full name: |
Date of birth: |
Street address: |
City/State/ZIP: |
Country of residence: |
Citizenship: |
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. Why do you want to participate in a Birthright Unplugged trip?
3. Have you ever been to Israel, the West Bank, or the Gaza Strip?
If so, please briefly describe the circumstances of your visit(s) and
tell us a little about your experience.
4. Have you had experiences with cultures different than your own?
Please describe any difficulties with this experience and/or lessons
learned.
5. 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?
6. What does it mean to you that we will be a mostly North American group traveling in occupied Palestinian communities?
7. What is your understanding of and relationship to Zionism?
8. Very briefly, what do you see as the root causes of the issues
in Israel/Palestine?
9. Are you involved in any social justice and/or organizing work or
passionate about any particular social justice issues? Please describe
the nature of your work and your reasons for doing it.
10. Should you be accepted to participate in a Birthright Unplugged
trip, how do you anticipate using what you learn?
11. What are some major questions you have about Israel/Palestine that
you would like to see addressed on a Birthright Unplugged trip?
12. Do you have any health problems 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.
13. Do you have any dietary restrictions i.e. vegetarian, vegan, allergies
etc…
14. Where will you be right before the trip, what dates are you available
to travel with Birthright Unplugged and do you have any flexibility
in the dates of your participation on the trip?
15. Is there anything else you want us to know about you?
16. Have you read the Participant Agreement? Should you be accepted,
are you prepared to sign the Agreement and mail in the non-refundable trip contribution ($700-$850 Unplugged and $250-$350 BDS Institute)?
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Birthright Unplugged B/D/S & I Institute Application
Please fill out this application and e-mail it to us at info@birthrightunplugged.org.
Personal Information:
Full name: |
Date of birth: |
Street address: |
City/State/ZIP: |
Country of residence: |
Citizenship: |
Telephone number(s): |
E-mail address: |
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 each question as thoroughly as possible.
1. Why do you want to attend Birthright Unplugged’s B/D/S & I Institute?
2. Please note your past B/D/S & I (Boycott/Divestment/Sanctions & Investment) work (check all that apply):
___ 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
3. Your B/D/S & I target communities & institutions (please name all that apply):
Religious institution: __________________________________________________
University: _________________________________________________________
City council/municipality: ______________________________________________
Union: _____________________________________________________________
Consumer products (to promote or boycott): _______________________________
Local store (department, grocery, etc): ___________________________________
4. What partners have you engaged or are you are planning to engage in B/D/S & I campaign work?
5. What obstacles do you anticipate encountering or have you encountered?
6. What skills, tools, relationships and other resources do you want to cultivate to be better able to conduct a B/D/S & I campaign?
7. Should you be accepted to the Institute, you will be asked to make presentations and to contribute to group conversations about the potential of B/D/S & I 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?
8. What materials do you plan to gather and bring with you in order to assist in your campaign development work and presentations?
9. Are you able to commit to making a two year commitment to providing support to B/D/S & I following the Institute? 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 Participant Agreement
Participant’s Name__________________________________
Please complete this form and mail it with your ($700-$850 Unplugged and $250-$350 BDS Institute) check (made out to
Birthright
Unplugged) to:
Birthright Unplugged
76 Day Street
Jamaica Plain, MA 02130
Birthright Unplugged Participant Agreement:
1. I agree to behave with respect for the cultural norms in the areas I visit
during the entire Birthright Unplugged trip. While in Palestine, I will make
an effort to observe the local cultural norms. These norms include not drinking
alcohol and not having flirtations with people I meet during the trip. Even after
the trip I will observe these norms when returning to communities introduced
to me by Birthright Unplugged. I understand that my presence in these communities
will continue to be associated with Birthright Unplugged, and violations of cultural
norms may jeopardize the organization’s relationships, reputation, and
work.
2. I agree to be sensitive to dynamics that may arise within the traveling group
and with 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 send my trip contribution to Birthright Unplugged upon acceptance,
and I understand that this goes towards the cost of the trip and is non-refundable
except in the case of trip cancellation.
5. I agree to participate in the program in full except in the case of illness
or emergency and in consultation with trip leaders.
6. 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.
7. I authorize Birthright Unplugged to record and edit video and photos taken
during the trip in which my likeness, image, voice, and interview may appear.
Birthright Unplugged may use and authorize others to use all or parts of the
video. Birthright Unplugged shall own all rights, title, interest and copyright
to the video to be used and disposed of without limitation and at 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.
8. I hereby release Birthright Unplugged from any liability in the event of any
damage or injury to my person or my property during, before, or after the Birthright
Unplugged trip.
Participant’s signature & date:
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_____________________________
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Parent or guardian’s signature
& date (required if under 18):
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_____________________________
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Participant’s name as it appears
in passport:
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_____________________________
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Passport number:
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_____________________________
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| Passport date of issue: |
_____________________________ |
Emergency contact name & relationship to you:
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_____________________________ |
| Emergency contact phone number & e-mail address: |
_____________________________ |
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