Sun & Study Application

Page 1

First Name

Middle Name

Last Name

What is your nickname? (If it's the same as your first name, please type your first name into the field below.)

Contact Information

Cell Phone

Home Phone

Email Address

Permanent Address

Street

City

U.S. State

Postal Code

Country

State/Province if outside of the United States

Family/Friend Who Introduced you to Sun & Study

Referral First Name

Referral Last Name

Referral Phone

Referral Email

Add another referral name?

Yes, please

Ref 2 First Name

Ref 2 Last Name

Ref 2 Phone

Ref 2 Email

If other, please explain

Page 2

School Information

Full Name of School

Other - School Name

Major

Year In School

Do you want to be considered for a scholarship?

Recommendation Information

Who is writing you letter of recommendation?

Please enter the number and email address of your reference. We will send a request for your letter of recommendation directly to this person.

First Name

Last Name

Relationship to you

Phone

Email (Warning! Do NOT enter your email address. Please enter the email of the person who'll be writing your letter of recommendation!)

Page 3

Help us get to know you

What are your hobbies, interests, clubs, volunteer experiences?

What is your previous Jewish education, if any, ex: Hebrew School, classes or Shabbat at Chabad, etc

How would you rate your Hebrew on a scale of 0-10, where 10 is most proficient.

Write two to three paragraphs about 1, your most memorable Jewish experience; OR 2, an individual you know who represents Judaism or Jewish values

Write one to two paragraphs describing what you hope to gain by attending.

Is there anything else you want us to know about you?

Facebook name?

Date of Birth (mm/dd/yyyy)

mm/dd/yyyy

Are you converting?

If you are converting, what is the name of your Rabbinic contact?

Phone of Rabbinic contact

Hebrew name, if known

Mother's Hebrew Name, If Known

Page 4

Medical Information

Do you have any medical, dietary, or other needs?

Please list any medications you’ll be taking during the trip. If there are none write none.

Do you have any allergies, including penicillin?

Emergency Contact Information

Emergency Name

Emergency Phone

Emergency Email

Relationship to you

I give permission to Sun & Study (and its sponsoring organization, Bais Chana Women International) to use photos, written quotes, audio or video of me in their promotional materials and for other non-profit purposes.

I agree to abide by all Bais Chana Women Intl safety and health protocols.

Page 5

When you click submit, you can review your responses then proceed to pay your $50 application fee. Your application is not complete until the application fee is paid.

If you are not applying for a scholarship, the program fee is $910. Pay now or email info@baischana.org to set up a payment plan.

Thank you!

Would you like to make a donation to Sun & Study?

Donation Amount

Total to be Paid Now