Jerusalem Fellowships Israel Trip

This application is for Jerusalem Fellowships Israel Trip. To apply for other trips, go to the below sites! *

Jerusalem Fellowships - Israel trip (approx. June 25 to July 10)

TO APPLY FOR THE LIVING LEGACY POLAND TRIP from May 14 to May 21, VISIT www.thelivinglegacy.ca

To apply for an Israel Internship Trip, visit JInterships at https://jinternship.com/

Other:

Last Name *

(as it appears on your passport)

First Name (and middle name if applicable) *

(as it appears on your passport)

Full Name as you would like it to appear on a name tag: *

Gender *

Female

Male

Other:

Cell number *

Home number *

Email *

Birthdate *

MM

/

DD

/

YYYY

Your Marital Status *

Passport Number *

If you are accepted on this trip, do you plan to extend? If no, choose option 1. If yes, choose "other" and fill in your ideal 2 dates. *

I will not be extending.

Other:

Street Number *

Street Name *

City *

Postal Code *

Country of Birth *

Mother's Full Name *

Mother's Occupation *

Father's Full Name *

Father's Occupation *

Parents Marital Status *

Parents Email Addresses: *

(Must be email address of parent or guardian - Do not put your own.)

Was your father born Jewish? *

Yes

No

Please summarize conversion history if any *

Was your mother born Jewish? *

Yes

No

Please summarize conversion history if any: *

Were all of your grandparents born Jewish? *

Yes

No

If no, please explain. *

Parents Jewish affiliation *

Reform

Conservative

Orthodox

Unaffiliated

Other:

How did you hear about the trip? *

Campus Student Organization

Friend/Relative

Email

Facebook Group or Ad

Aish Campus Rabbi or Staff

Google

Please enter the name of the referring individual or organization *

Please list the names of people you know who have participated on this program in the past *

School Information: Name of University/College attending/attended: *

School Information: Major: *

School Information: Year of Graduation *

Employment Information (Mandatory if graduated): Current Employer: *

Employment Information: Job Description/Planned Career: *

What extracurricular activities, hobbies and organizations are you involved in? Please describe your participation in them: *

What Jewish Education have you had? *

Virtually None

Hebrew School/Sunday School pre age 13

Hebrew School/Sunday School post age 13

Jewish Day School

Yeshiva High School

Other:

What was the Jewish Affiliation of your Hebrew School *

Reform

Conservative

Orthodox

Unaffiliated

Other:

If you attended Day School, how many years did you attend? *

What was the Jewish affiliation of your Day School? *

Reform

Conservative

Orthodox

Unaffiliated

Your Current Jewish Affiliation: *

Reform

Conservative

Orthodox

Unaffiliated

Other:

Do you hold any leadership/professional postitions in Jewish organizations?: *

Yes

No

Leadership Position : *

Have you been to Israel before *

Yes

No

In What Context? (Bar/Bat Mitzvah, Year abraod, March of the Living, birthright israel, Yeshiva study, etc.) *

What types of Jewish experiences have you had?(Bar Mitzvah, youth group, fraternity/sorority, etc) *

My top 4 life priorities are: *

Reference 1: Please include Name, Relationship, Phone Number, Best time to reach him/her and Email *

Reference 2: Please include Name, Relationship, Phone Number, Best time to reach him/her and Email *

Do you have any accessibility requirements or physical limitations or restrictions? *

Yes

No

If so, please elaborate: *

Do you have any special dietary requirements or food allergies? *

yes

no

Special dietary requirements or food allergies: Please elaborate *

To ensure the safety of participants we have to ask a few physical and mental health questions. Are you currently receiving medical treatment or psychological counseling? *

Yes

No

Medical treatment or psychological counseling: Please elaborate *

Are you currently taking any medication? *

Yes

No

Medication: Please List medications *

Have you ever been hospitalized? *

Yes

No

Hospitalized: Please elaborate *

Are you a practicing Jew: *

Compared to others, Jewish causes are: *

Desire to be close to Jewish people *

Has Aish attributed to your growth: *

How do you identify yourself? *

How is Torah relevant to you? *

How often do you help fellow Jews? *

How often do you learn Torah? *

What is your attitude to marriage? *

Will your children's education have: *

All applicants are required to register with our scholarship provider (Olami) in order to receive our trip scholarship. Therefore, your application will only be considered once this is complete. Educator is Rabbi Shlomo Blackman: http://register.olami.org/. *

Check here once you've completed the form

Required

With programs in over 30 countries, Olami and its funding partners sometimes use independent verification firms to assure that programs are attended and impactful. By registering, I understand that I might be contacted by a verification firm for quality control purposes. *

Yes

Required

Olami is funded in part by Mosaic United. Check "no thank you" if you don't want to be contacted regarding future Mosaic sponsored-opportunities.

No thank you

To complete this application, please pay your $50 deposit: https://buy.stripe.com/14kg2z3QUfe30Ja3cp Please note, if due to high demand we dont accept you on this trip, we will refund your money. YOU WILL BE CONTACTED FOR AN INTERVIEW. For further information, please email mgreenspan@aish.com *

Check here once you've paid $50 at the link provided

Required