2023 BJE March of the Living TEEN Application

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BJE March of the Living 2023 Teen Application

Program Dates: April 16 - April 28, 2023

DUE BY OCTOBER 31, 2022

TEEN INFORMATION

For Homeland Security purposes, your name must be EXACTLY as it appears on your passport:

First name

Middle name

Last name

Nickname - How would you like your name to appear on your name badge?

Gender:

FemaleMaleI prefer to self describe (please do so in "My preference is" box below)

If you 'prefer to self describe', what are your preferred pronouns?

Birthday (month)

Birthday (Day)

Birthday (Year)

Address

City

State

Zip Code

Cell Phone Number

TEEN Email Address (that you check most often)

EDUCATIONAL INFORMATION

High School

If 'other' - what high school are your attending?

Your grade as of September, 2022?

If 'other' - please explain

Are you planning on taking AP Exams in May?

YesNo

TEEN WELLNESS - this information is confidential.

Have you received both doses of the COVID-19 vaccine? (please note, a booster may be required depending on date of vaccination)

YesNo

Do you take daily medication?

YesNo

Have you seen a mental health professional in the past two years?

YesNo

PARENT / GUARDIAN CONTACT INFORMATION

Who is the primary contact?

Mother/Guardian 1Father/Guardian 2

Mother/Guardian 1's Information

First Name

Last Name

Cell Number

Email Address

Father/Guardian 2's Information

First Name

Last Name

Cell Number

Email Address

FINANCIAL AID

Would you like to receive information regarding financial aid?

T-SHIRT & JACKET SIZING

What size BJE MOTL t-shirt would you like - adult sizing?

What size BJE MOTL jacket would you like - adult sizing? The jackets run approximately 1 size larger.

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PERSONAL PROFILE

Why do you want to participate in BJE March of the Living?

Is there anything that you are concerned or nervous about regarding the BJE MOTL experience?

Have you ever been to Israel?

Have you ever been on an organized trip to Israel (ex: Tiferet, SIEP, Ramah Seminar, USY Pilgrimage etc.?) If so which one?

Have you ever been to Poland? If so, when?

Did any of your siblings participate in the BJE MOTL in past years?

YesNo

If yes, what are their name(s)?

Have you suffered a significant loss recently?

YesNo

If yes, please explain:

Are any members of your family Holocaust Survivors?

YesNo

Name(s):

Relationship:

Briefly tell us their story (if you know it).

Do you have a criminal record?

YesNo

If yes, please explain.

REGISTRATION

PLEASE NOTE:

Admission is on a first come first serve basis for qualifying students. In addition to the application, a personal interview is required as part of the acceptance process.

BJE maintains a wait list of qualifying applicants, once the program has filled.

By submitting this form, you have completed the first step of the application process.

Next Step:

Your parent(s)/legal guardian(s) will be contacted via email letting them know that you have started the application process for the 2023 BJE March of the Living program.

Parents will need to log in and create their 'parent profile.'

Your application will not be considered complete unless we have the relevant documents as stipulated by the due dates on Part B.