Fellowship Application

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APPLYING ON-LINE for The Hasbara Fellowships: Winter 2014-2015

Please fill in all the required information (as denoted by *), otherwise your application will not be accepted.  After submitting this application you will automatically receive a confirming email.  Please notify us of any address or phone number changes at  nrefael@hasbarafellowships.org or call 1-646-365-0030.

Please make sure to click the "Submit" button at the bottom of this page when you are finished filling out the form. Then, review your information on the next screen and click the "Submit" button at the bottom of that screen.
YOU MUST CLICK THE SECOND SUBMIT BUTTON IN ORDER TO APPLY.

Please use the field below to include a recent photo of yourself in gif or jpg format.
(Use the Browse button to find your picture's location on your computer. Max size is 2 MB.)

* Upload photo:

Program and Preferred Dates
*
Preferred Program:  
General Information
* First Name:
* Last Name:
* Date of Birth:   (mm/dd/yyyy)
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:
Other University/College
* Major

Employment Information (Mandatory if graduated)

Current Employer:
Job Title: 
Your Contact Information
* Address:
* City:
* State/Province:
* Zip:
* Country:
* Phone Number: (###-###-####)
* Phone Number Cell/Work: (###-###-####)
* Personal E-mail:
* School E-mail:
* Your Marital Status: 
Permanent/Parents' Home Address
* Residence of:
* Address:
* City:
* State/Province:
* Zip:
* Country:
* Father's Emergency
Phone Number:
(###-###-####) Enter "1" if N/A
* Mother's Emergency
Phone Number:
(###-###-####) Enter "1" if N/A
  Fax: (###-###-####)
* E-mail:

Family Background

* Mother's First Name:
* Mother's Last Name
Mother's Occupation
* Father's First Name:
* Father's Last Name:
Father's Occupation
* Parents' Marital Status:
*

Was your father born Jewish?

Please summarize conversion

history if any

 

*

Was your mother born Jewish?

Please summarize 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?
*
Please describe your specific role in Israel activism on campus and/or in your community:
 
 

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 you specified "Other" Please expain
 
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?
 
 

Position:
 
*
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 include name, address, phone, relationship to you and the best time of day he or she can be reached.  Please do not include family or friends
Reference 1
  Name  
  Relationship  
  Address  
  Phone number  
  Best time to reach him/her  
  Email  
Reference 2
  Name  
  Relationship  
  Address  
  Phone Number  
 
Best time to reach him/her
 
  Email  

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.