Pardes Summer Program Application Form

Date of Birth MM/DD/YYYY:

Gender:

Marital Status:

(only if applicable) Partner's Last name:

Partner's First name:

Mobile Number

Home Phone Number:

Please include full dialing codes

Permanent Address

Permanent Address Line 1:

Permanent Address Line 2:

City:

State

ZIP Code:

Country

Current address if different from address above

Current Address Line 1:

Current Address Line 2:

City:

State

ZIP Code:

Country

Name of Undergraduate Institution:

Enter school name if not found on drop down list:

Location:

Major/Field of Study:

Enter major field of study if not listed:

Undergraduate Degree:

Enter undergraduate degree if not listed::

Start Date MM/DD/YYYY:

End Date MM/DD/YYYY:

Comments:

Name of Graduate Institution:

Enter school name if not found on drop down list:

Location:

Graduate Degree:

Enter graduate degree if not listed:

Major/Field of Study:

Enter major field of study if not listed::

Start Date: MM/DD/YYYY

End Date MM/DD/YYYY:

Current Full Time Employment (if applicable)

Employer:

Position:

Location: City

State

Country

Start Date MM/DD/YYYY

End Date MM/DD/YYYY:

Organizational Involvement #1 (Non-Jewish)

Organization Name:

Position:

Location: City

State

Country

Start Date (MM/DD/YYYY):

End Date (MM/DD/YYYY):

Comments:

Organizational Involvement #2 (Non-Jewish)

Organization Name:

Position:

Location: City

State

Country

Start Date (MM/DD/YYYY):

End Date (MM/DD/YYYY):

Comments:

a. Jewish Education

Name of Jewish Learning Institution #1:

Location: City

State

Country

Area of Study:

Level:

Start Date:(MM/DD/YYYY)

End Date:(MM/DD/YYYY)

Comments:

Name of Jewish Learning Institution #2:

Location: City

State

Country

Area of Study:

Level:

Start Date:(MM/DD/YYYY)

End Date:(MM/DD/YYYY)

b. Jewish Summer Camp

Name of Camp:

Enter name of Camp if not found on drop down list:

Location: City

State

Country

Position(s) (i.e. camper, counselor, etc.):

Start Date: (MM/DD/YYYY)

End date:(MM/DD/YYYY)

c. Hillel Foundation for Jewish Campus Life

Are/were you a member of Hillel while an undergraduate student?

YesNo

Position(s):

Start date: (MM/DD/YYYY)

End Date:(MM/DD/YYYY)

Comments:

Are/were you a member of Hillel while a graduate student?

YesNo

Position(s):

Start date: (MM/DD/YYYY)

End Date:(MM/DD/YYYY)

Comments:

Adamah Start date MM/DD/YYYY

Adama End date MM/DD/YYYY

Adamah - Position

AJWS Start date MM/DD/YYYY

AJWS End date MM/DD/YYYY

AJWS - Position

Avodah Start date MM/DD/YYYY

Avodah End date MM/DD/YYYY

Avodah - Position

BIMA at Brandeis Start date MM/DD/YYYY

BIMA at Brandeis End date MM/DD/YYYY

BIMA at Brandeis - Position

BCI Start date MM/DD/YYYY

BCI End date MM/DD/YYYY

BCI - Position

Genesis - Start date MM/DD/YYYY

Genesis - End date MM/DD/YYYY

Genesis- Position

JDC Start date MM/DD/YYYY

JDC End date MM/DD/YYYY

JDC - Position

JOI Start date MM/DD/YYYY

JOI End date MM/DD/YYYY

JOI - Position

Maimonides Leaders Fellowship Start date MM/DD/YYYY

Maimonides Leaders Fellowship End date MM/DD/YYYY

Maimonides Leaders Fellowship - Position

Teva Start date MM/DD/YYYY

Teva End date MM/DD/YYYY

Teva - Position

e. Additional Jewish Organizational Involvement

Jewish Organization #1 Name:

Position(s):

City

State

Country

Start date: (MM/DD/YYYY)

End Date:(MM/DD/YYYY)

Comments:

Jewish Organization #2 Name:

Position:

City

State

Country

Start Date: (MM/DD/YYYY)

End Date: (MM/DD/YYYY)

Comments:

a. Study Abroad Program at an Israeli University

University

Other University if not found on drop down list

Area of study

Start date (MM/DD/YYYY)

End date (MM/DD/YYYY)

b. Selected organized programs to Israel If you participated in any of these organized programs to Israel (see drop-down lists), please indicate dates of participation and position.

Program #1:

Position (i.e.participant, staff)

Start date (MM/DD/YYYY):

End date (MM/DD/YYYY):

Program #2:

Position (i.e. participant, staff)

Start date (MM/DD/YYYY):

End date (MM/DD/YYYY):

c. Other organized programs to Israel

Name of Program:

Position (i.e. participant, staff)

Start date (MM/DD/YYYY):

End date (MM/DD/YYYY):

Synagogue/Minyan

Name:

Rabbi's Name:

Affiliation

Other affiliation:

City

State

Country

Comments:

Rate yourself on your Hebrew Language skills (provided dictionary assistance) Read a voweled text without comprehension

Yes GoodWith difficulty Unable

Read and comprehend a biblical passage

FluentGoodWith difficulty Unable

Read a newspaper article in Hebrew