PHILLY-ISRAEL FELLOWSHIP: A CHEVRA & DAVAI LEADERSHIP EXPERIENCE!
2012 APPLICATION
Questions marked with
*
must be answered before submitting the application!
First Name:
*
Last Name:
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Home Phone:
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Cell Phone:
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EMail:
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Date of Birth (mm/dd/yyyy):
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Gender:
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Male
Female
Please select
Country of Birth:
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United States
Former Soviet Union
Other
If you were not born in the US, year of arrival in to the US:
Street Address:
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City:
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State:
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Zip:
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Marital Status:
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Single
Married
Separated
Divorced
Other
If married, name of your spouse:
Mother's First Name:
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Mother's Last Name:
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Father's First Name:
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Father's Last Name:
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Was Your Father Born Jewish?:
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Yes
No
Please select
Was Your Mother Born Jewish?:
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Yes
No
Please select
Undergraduate University/College Attended:
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Year of Graduation/Projected Graduation:
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Undergraduate Major:
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Graduate School Attended:
Year of Graduation/Projected Graduation:
Graduate School Major:
Current Employment Status:
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Full Time
Part Time
Student
Unemployed
Name of Company:
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Position/Title:
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Have you participated in Jewish educational programs before?:
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Yes
No
Please select
If yes, please list which program(s) (include location and year):
Have you participated in a Birthright Trip to Israel?:
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Yes
No
Please select
Do you read Hebrew?:
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Yes
No
Please select
Do you speak Hebrew?:
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Yes
No
Please select
Have you attended a Jewish school?:
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Yes
No
Please select
If yes, what was the name of the school?:
What is your current Jewish affiliation?:
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Secular
Reform
Reconstructionist
Conservative
Orthodox
Other
Have you held any leadership/professional positions in Jewish organizations?:
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Yes
No
Please select
If yes, please describe:
Please list any friends who are applying with you to this program:
Please briefly explain what you hope to gain from the Chevra/Davai Experience:
*
How did you hear about the program?:
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Email
Recruiter
Newsletter
Facebook
Friend
Other
Name of person or organization who told you about the program: