APPLYING ONLINE for the Hasbara Fellowships Israel Program: Winter 2017-2018

Please fill in all of the required information (as denoted by *), otherwise your application will not be accepted. Please notify us of any address or phone number changes by emailing agratz@hasbarafellowships.org or by calling our office at (646) 365-0030.

Please make sure to click the "Submit" button ONLY ONCE at the bottom of this page when you are finished filling out the form.

Our Partners:

AEPi Fraternity

Students Supporting Israel  

 

 

Israel Program Application

Homepage » Apply for Israel Program » Israel Program Application
Program and Preferred Dates
* Preferred Program:



General Information
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* Date of Birth (XX/XX/XXXX): 

* Passport No.:  

Name as it appears on Passport:  

* Gender:  

* How did you hear about the program?:

Please enter the name of the referring individual or organization, if applicable:

* Country of Birth:




School Information
* Year of Graduation:  

* School Status:  

* University/College:  

* Major:  


Employment Information (Mandatory if Graduated)
Current Employer:   

Job Title:  


Your Contact Information
* Permanent 


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* School E-mail:


* Facebook Profile Link:


* Your Marital Status:




Permanent/Parents Home Address
* Residence of:  

* Parents' Address:  

* Parents' City:  

* Parents' State:  

* Parents' Zip:  

* Parents' Country:  

* Father's Emergency Phone Number:  

* Mother's Emergency Phone Number:  

Parents Fax:  

* Parents Email:  


Family Background
* Mother's First Name:  

* Mother's Last Name:  

* Mother's Occupation:  

* Father's First Name:  

* Father's Last Name:  

* Father's Occupation:  

* Parent's Marital Status:  

* Was your father born Jewish?:   

Father's conversion history (if any):

* Was your mother born Jewish?:   

Mother's conversion history (if any):

* Parents Jewish Affiliation:   

* Were all your grandparents born Jewish?:

If no, please explain:




Years of Education and Activism
* How many years of education (starting with first grade) completed?:


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Jewish Background
* What Jewish Education have you had?:  

If you attended afternoon Hebrew School, how many years did you attend?:  

What was the Jewish Affiliation of your Hebrew School?:  

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

What was the Jewish Affiliation of your Day School?:  

* Your Current Jewish Affiliation:  

* How would you describe your Jewish education?:  

If specified "Other" please explain:

How would you describe your Hebrew speaking skills?:  

How would you describe your Hebrew reading skills?:  

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

If Yes what Position and Organization:

* Have You been to Israel before?:  


In What Context? (Bar/Bat Mitzvah, Year abroad, March of the Living, birthright israel, Yeshiva study, etc.) (Max 255 characters):

* What types of Jewish experiences have you had? (Bar Mitzvah, youth group, fraternity/sorority, etc) (Max 255 characters):




References

Please provide at least 1 professional reference (ie: Hillel Director, Campus Rabbi, Israel Fellow, etc.)

*Reference 1 Name:  

*Reference 1 Relationship:  

*Reference 1 Address:  

*Reference 1 Phone number:  

*Reference 1 best time to contact:  

*Reference 1 E-Mail:  

Reference 2 Name:  

Reference 2 Relationship:  

Reference 2 Address:  

Reference 2 Phone number:  

Reference 2 best time to contact:  

Reference 2 E-Mail:  


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

If so, please elaborate:

* Do you have any special dietary requirements?:  

If so, please elaborate:

* Are you currently receiving medical treatment or psychological counseling?:  

If so, please elaborate:

* Are you currently taking any medication?:  

If so, please elaborate:

* Have you ever been hospitalized?:  

If so, please elaborate: