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Applicant Name *

Hebrew Name

Legal Address

Which session(s) are you applying for? *

Jintern?

Contact Information

Email *

Cell phone *

Mailing Address

If different from above.

Work phone

Home phone

Emergency contact number

Background Information

Date of Birth

Place of Birth

Citizenship

Were you ever in Israel?

Was your mother born Jewish? *

Was your father born Jewish ? *

Parent's marital status

Father’s name

Father’s occupation

Father's employer’s name

Mothers name

Mother’s occupation

Mother's employer’s name

Are there other children in the family?

Education Data

List chronologically all the schools you have attended. Include name of school, location, dates of attendance, graduation date and any degrees awarded.

Colleges or Universities

Jewish Schools (if not included above)

Present occupation, if not attending college

Please detail a brief career bio

Jewish Education

Hebrew: Rate your proficiency

Speak

Write

Read

Understand

Detail areas of subject matter studied in following

Bible

Hebrew Literature

Jewish History

Talmud

Other

Additional Information

Languages spoken at home

Activities and organizations in which you have participated

Do you need financial assistance in meeting the tuition requirement of $350?

Before May 15th, the tuition will be $350. After that time it will be $400.

Are there any special characteristics of your medical history (including medicines, physical limitations or food requirements)?

References

List two persons who can serve as a reference for you.

Reference #1 - Name

Reference #1 - Relationship

Reference #1 - Phone/Address

Reference #2 - Name

Reference #2 - Relationship

Reference #1 - Phone/Address

How did you hear about Sinai Retreats?

Please describe what you hope to gain from Sinai Retreats.

[For jinternship only] Please enter your congressman district information

Please upload a profile picture

Click or drag a file to this area to upload.

Any reasonably clear headshot should be fine. This is for internal identification purposes only.