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 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

* 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 








* 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):

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: