Contact
Information
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| First Name |
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| Last Name |
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| Gender
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| Date of Birth |
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| School
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| If Other (specify) |
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Home Address |
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| City |
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| State |
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School Address |
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Cell Phone |
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Dorm/Apt Phone |
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E-Mail Address |
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Family
Information
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Father’s Name |
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Mother’s Name |
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What is your father's occupation? |
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What is your mother's occupation? |
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Parent’s Phone Number |
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Where was your father born? |
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Where was your mother born? |
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Parent’s
Marital Status |
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Is your
Mother born Jewish? |
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Is your
Father born Jewish? |
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List the names, ages of your siblings and whether any
of them are in college right now : (John Doe in/not in
college). |
1.
2.
3.
4.
|
Educational
Information
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Current year in school |
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Major |
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Which high school did you attend? |
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Please list whatever
experience you have had in the area of Israel Advocacy
and Education |
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Have you ever been to an
AIPAC conference? If yes, please list the years and
locations |
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List any academic honors or other distinctions that you
have received since the ninth grade. |
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Have you been to an AIPAC conference in the past? |
|
| If so with what
organization? |
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Please a recommend a friend that may be interested in
this or other JAM Trips. |
| Name |
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| Cell Phone |
|
| College Info |
|
| Email Info |
|
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What have you done over the past two summers? |
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What are your plans for next year? |
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List the extracurricular activities you have been
involved in (including high school) and describe your
participation. |
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Please list your past jobs (entries in chronological
order, beginning with the most recent.) |
1.
2.
3.
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Miscellaneous Information
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Do you have any “formal’” Jewish Education? If so,
please list the Jewish schools you attended together
with the dates.
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Have you ever sought psychological counseling?
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How did you hear about this trip, or who referred you? |
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Are you or have you been, a member of a Jewish
organization? If so, which one.
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Describe your Jewish observance:
|
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Are you taking any type of medication?
|
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Do you have any special medical need?
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Do you know people coming on this trip or any of our
other trips? If so, who?
|
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What are your life's top four priorities? |
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