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ECA: Young Entrepreneurial Fellows University of Michigan Dearborn, College of Engineering and Computer Science Henry Patton Center for Engineering Education and Practice (UMD-CEEP) Dear Applicant, Please fill out this application form accurately. We are looking for young professionals from Algeria, Egypt, Israel, Morocco and the Palestinian Authority who are, or hope to be entrepreneurs, or who are actively involved in promoting or supporting entrepreneurship in their respective countries. Please submit completed application with a CV to Ms. Barbara Peitsch at bpeitsch@umd.umich.edu. You may also contact Ms. Barbara Peitsch at 1-313-583 6385 for additional information or questions. Eligibility: Professional men and women from Algeria, Egypt, Israel, Morocco, the Palestinian Authority and Tunisia. Ideal candidates will be between the ages of 18 and 35. Applicants will be recruited from secondary schools, colleges and universities, government agencies, NGOs, and entrepreneurial organizations. Due Date: January 23,2012

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7. Fax Number: _________________________________________________________ 8. E-mail Address:_______________________________________________________ 9. Age:____________________________________________________________

____ 10. Profession ___ Education Sector (e.g., secondary school, college or university) ___ Vocational Training ___ Community Leader ___ Youth Development Leader ___ Non-Government Organization Representative ___ Government Employee ___...