New Application for the Visionary Leadership Award

Application for the Visionary Leadership Award

in the Tradition of the Prophet Muhammad (PBUH)
Name*

First NameMiddle NameLast Name
Are you applying as an individual or representative of an organization?*

IndividualRepresentative of an organization
If applicable, name the organization that you represent*
Would you like to be considered for the IRUSA Black/African American Muslim Scholarship?*

YesNo
Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Gender*
Date of Birth*
Were you born into a Muslim family?*

YesNo
Are you Hispanic or Latino?*

YesNo
Select one or more of the following:*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite
Select your highest level of education*
There is no particular level of education required for this reward.
Please give a brief description of your Islamic education and training outside and inside of the US*
Please upload your CV or email it to info@islamicseminary.us with the subject "Visionary application."*

Browse Files

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Please give a brief description of your general education and training outside and inside of the US*
Please list all of your paid and volunteer services performed in the Muslim Community and outside the Muslim Community.*
Please provide 3 character references, including their name, relationship, phone, and email. One reference must be someone from outside of the Muslim community.
Reference: 1*
Reference 2*
Reference 3*
Please submit a 300-650 word essay on how you envision the future of Islam in the US and why you should be a part of this leadership development program. Please note that this program focuses particularly on building leadership capacity for women and those who serve economically stressed communities.*
What will be your primary focus in this program?*

Professional developmentOrganizational development
Date*

MonthDayYear
Date
If I receive this award, I grant permission to use my photograph and information about me for public disclosure and donor/funder reporting requirements.*

I agree
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