APPLYING ON-LINE for Essentials -- Fall 2014 - Spring 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  jf@aish.com or call 1-845-425-8255 ext. 201. Confidentiality will be maintained for all personal information. Reporting inaccurate informtion on the application is grounds for disqualification and/or dismissal from the program.

Program and Preferred Dates
*
Program Dates:  
General Information
* First Name (and middle if applicable) as it appears
on your passport):
* Last Name as it appears
on your passport:
* Full Name as you would
like it to appear on a name tag:
* Date of Birth:   (mm/dd/yyyy)
Passport No:  
* 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 :
* University/College:
 

Employment Information (Mandatory if graduated)

Current Employer:
Job Title: 
Your Contact Information
* Address:
* City:
* State/Province:
* Zip:
* Country:
* Phone Number: (###-###-####)
* Phone Number Cell/Work: (###-###-####)
* E-mail:
* Your Marital Status: 
Permanent/Parents' Home Address
* Residence of:
* Address:
* City:
* State/Province:
* Zip:
* Country:
* Phone Number: (###-###-####)
  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.

  



Educational History

  *  How many years of education (starting with first grade) completed?
*
What extracurricular activities, hobbies and organizations are you involved in?  Please describe your participation in them:
  
 

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.)
*
What types of Jewish experiences have you had? (Bar Mitzvah, youth group, fraternity/sorority, etc)
 


Please be sure to include any Aish travel/study programs on which you've previously participated.

  My top 4 life priorities are:
*
1.
*
2.
*
3.
*
4.
    

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

Strict confidentiality will be maintained for all personal information supplied.
*
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.   
  

Scholarship Information

 

*
Are you requesting a flight scholarship?
 

If so, please elaborate.

  
*

Have you received a Maimonides Scholarship?

  
       
       
       
       
       
Survey
* Are you a practicing Jew:  
* Comp to others, Jewish causes are:  
* Desire to be close to Jewish people:  
* Has Aish attributed to your growth:  
* How do you identify yourself?:  
* How is Torah relevant to you?:  
* How often do you help fellow Jews:  
* How often do you learn Torah?:  
* What is your attitude to marraige:  
* Will your children's education have: