PCJE SENIOR EDUCATOR LEARNING FELLOWSHIP

Page 1

APPLICANT INFORMATION

Title

First Name:

Middle Name:

Last Name:

Date of birth MM/DD/YYYY:

Email Address:

I have participated in one of the following Pardes in-person program(s). (If you participated in more than one program, please specify in the comments section)

Year(s) Participated

Further Comments

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ADDITIONAL PERSONAL INFORMATION

Preferred Name (If applicable)

Country of Citizenship

CONTACT INFORMATION

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

Current address good until MM/DD/YYYY:

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HIGHER EDUCATION

Name of Undergraduate Institution:

Enter school name if not found on drop down list:

Undergraduate Degree:

Major/Field of Study:

Enter major field of study if not listed:

Name of Graduate Institution:

Enter school name if not found on drop down list:

Graduate Degree:

Enter graduate degree if not listed:

Major/Field of Study:

Enter major field of study if not listed:

STUDY BACKGROUND

Please rate your prior knowledge in the following areas. Please note that this program is open to learners of all levels.

Prior experience with Torah/Tanakh

BeginnerSome Background (< one year)Intermediate (> one year)Advanced

Prior Experience with Talmud

BeginnerSome Background (< one year)Intermediate (> one year)Advanced

School Details

How long have you been working in Jewish Education?

At what congregational school do you currently work?

Congregational school web address:

Congregational school mailing address:

What denomination, if any, is your congregational school associated with?

Roughly how many students are enrolled in your congregational school?

Do you have any other teaching or educational experience? If so, please elaborate.

Your current job description (please include supervisory roles):

SUPERVISOR DETAILS

Name:

Position:

Email:

Phone (include country and area code, preferably Whatsapp)

JEWISH PROFESSIONAL DEVELOPMENT INVOLVEMENT

What professional development programs have you participated in (i.e JNTP, M2, Prizmah...)?

GOALS

What professional goals do you hope to achieve by participating in the Senior Educator Learning Fellowship?

Describe how you hope the role/s you play at your congregational school will be positively impacted by participating in the Senior Educator Leadership Fellowship.

How do you imagine using Maklokhet Matters(constructive disagreement training) in your synagogue?

HEALTH:

General Health: If you have a special need/health concern, be it physical or psychological, that may affect your in-person participation, please share below.