APPLYING ONLINE for HASBARA 2.0 WINTER 2017-2018

Trip Dates:
December 17 - January 1
December 25 - January 10

 

Please fill in all of the required information otherwise your application will not be accepted. Please notify us of any phone number or address 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.

Hasbara 2.0 Application

Homepage » Apply for Israel Program » Hasbara 2.0 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:


* 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?:
*


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
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: