Mayanot | Institute of Jewish Studies

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Contact Information

Date of Birth

Gender

How old will you be when you intend to arrive to Mayanot?

Program applying for:

First Name

Last Name

Hebrew Name

Phone Number | Accepted format: +countrycodeareacodephonenumber

(e.g.: +18181234567) Where the red number is the country code, the yellow number is the area code and the green number is the phone number.

WhatsApp associated number (if different). | Please use int'l format.

Street

City

Country

US State

Canadian Provinces

Australian Provinces

Postal Code

Best time to contact. Please write which day of the week and time of day is best to reach you.

Time #1

Time #2

Time #3

Occupation

Marital Status

Parents' Information

Father's first name

Father's last name

Father's cell phone number

Mother's first name

Mother's last name

Mother's cell phone number

Mother's email address

Father's email address

Jewish Background

Were you born Jewish?

Did you convert to Judasim?

What is the name of the converting rabbi?

What is the name of the converting rabbinical court?

Was your mother born Jewish?

Did your mother convert to Judaism?

What is the name of the converting rabbi?

What is the name of the converting rabbinical court?

Was your maternal grandmother born Jewish?

Did your maternal grandmother convert to Judaism?

What is the name of the converting rabbi?

What is the name of the converting rabbinical court?

Health

Do you have any history of eating or dietary disorders or are currently exhibiting signs of either?

Please explain the eating disorder history below:

Have you been hospitalized in the past?

Please list all hospitalizations with date and duration along with a short description of each instance.

Have you ever received psychological treatment and/or counseling in the past?

Please describe the kind of treatment and/or counseling. List the date, duration, and if relevant, the supervising doctor.

Have you ever had any medical or emotional conditions?

Please describe each instance of a medical or emotional condition. Additionally, please list the date, duration, and supervising doctor

Are you currently taking any medications?

Please list each medication, its dosage, and the condition it's meant to treat.

Please list any restrictions on activities, i.e. swimming, hiking, etc...

Please include anything else you think we should know with regard to your health.

I agree to pay for any costs associated with mental health treatment that may not be covered by insurance should Mayanot's Education Director determine it necessary.

Yes, I agree.

General Education

Elementary School

Secondary/High School

Name

GPA

Are you a university student?

University Information

Name

Degree

GPA

Graduation Date

How did you hear about Mayanot?

Mayanot Israel Birthright Staff Member

Friend/Other

My Chabad Rabbi or Rebbetzin's Contact Details

First Name

Last Name

City

Phone | Please use int'l format.(+18181234567)

I agree to have the above person copied on future email correspondence regarding my acceptance and arrangements.

YesNo

Chabad on Campus Staff Member's Name.

Zalman SchurderYossi WitkesChaya SchurderOther

Other:

Personal References

First name	Last name	Phone Number	Email Address	Relationship

Jewish Education

Learning Goals and getting the most out of your time with us:

Mayanot generally focuses on furnishing beginner students with Hebrew skills to study classic Jewish texts (Talmud, Halacha, Chassidut) independently. This usually requires some level of pre-requisite Hebrew and a certain time and progress commitment (consistency) to achieve.
Alternatively Mayanot has our foundational Judaic Studies Program which is more lecture based and only uses Hebrew text in conjunction with an English translation - this course level is perfect for the beginner to build foundation in Jewish thought and practice.

Program Orientation

Skills-basedLecture-based

Which synagogue or temple do you affiliate with, if any?

Did you participate in any formal or informal Jewish classes and/or programs BEFORE graduating high school?

Please describe the nature of the classes and/or programs.

Did you participate in any informal or formal Jewish classes and/or programs SINCE graduating high school?

Which Birthright season were you on?

Who was the Birthright trip provider?

Please describe the nature of the classes and/or programs.

Essays

Describe your current occupation, passions, and interests.

Tell us about setbacks you have faced.

Describe your motivations and goals for studying at Mayanot. (300-400 words.)

Photograph Submission

Please upload a recent portrait photograph of yourself.

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Chassidus	Chumash
Ethics	Halacha (Jewish Law)
Hebrew language	Holidays
Jewish history	Kabbalah
Kosher	Land of Israel
Marriage	Mishna
Mussar	Personal growth
Philiosophy	Prayer
Shabbat	Talmud (content)
Talmud (skills)	Tanach (Bible)
Tanya

	Fluent	Very Good	Good	Fair	Unable
Reading Aloud (from vowelized text)
Reading Comprehension
Speaking