Name

Address (please put home address if attending college)

Date of Birth   Phone

Email address (required)

School currently attending

If in college, indicate your major (if you have selected one)

Describe your involvement in Jewish activities (please note any leadership roles you have played)

Describe your involvement in social action activities

Work experience (include non-paid positions such as internships and volunteer activities)

Special interests, hobbies, other relevant experience

Amount of money requested, and rationale

Essay: Please write a short (2 pages, max) essay, describing:

A. The Israel program you want to participate in (or create) 
B. Why this experience is important to you, and what you hope to gain from it 
C. The ways in which you will share your learning with a larger community, when you return