2021 Diller Teen Tikkun Olam Awards Application

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Page 1 - Background Information

The Diller Teen Tikkun Olam Awards recognize Jewish teens in the United States who have demonstrated remarkable leadership and initiative in projects that embody the values of  tikkun olam, “repairing the world." 


All application questions should be completed by teen applicants. 

A complete application for the 2021 Awards requires only an application form submitted by the teen - formal nomination and/or reference letters are not required, though on page 3 of this application you will need to provide the names of three people who know and can speak to your leadership of the project for which you are applying. 

We recommend drafting and saving long form answers prior to submitting online. You can draft your answers in this downloadable form

For more information or support: dillerteenawards@sfjcf.org; 415-684-8618
To reach us via text: text diller to 31996. 

To use the Save and Resume feature
Before saving your form, please make sure you have filled out each of the four fields in this section. Then you can use the "Save my progress and resume later" feature. Please make sure to note your password so you can easily access your saved form.


To be eligible for the award, the following statements must be true. Teens are not eligible for the Award if they have a sibling who has received a Diller Teen Tikkun Olam Award in the preceding five years.  

If not “True” or you are unsure, please contact the Tikkun Olam Award Team before proceeding to confirm eligibility.

Your Information

Page 2 - Project Information

Please note the varied word limits indicated for each question, which are tracked for you by the word counter below the field.

About Your Project


Please briefly describe the impact of your project (a list or short phrase is sufficient):


Project Background/Origin

Teens who have created and co-led with others are welcome to apply individually for the Tikkun Olam Award. In such cases, each applicant will be considered and evaluated separately, and no more than one applicant can be selected as an award recipient.

Length of Project


(hours per week)

Support/Engagement of Others

Finances, Donations, and Accounting

Ex.) .doc, .docx, .xls, .xlsx, .csv, .pdf, .jpg, .jpeg, etc. Google drive attachments not compatible.

Page 3 - Additional Information

Outside Volunteering / Additional Information

If not applicable, write N/A

If not applicable write N/A

Additional Documents (Optional)

If there are materials you would like the committee to consider along with your application, please include those in a single .pdf file with a maximum of ten pages. If your .pdf is longer than ten pages, the additional page will be excluded from your application.

It is often helpful to see fundraising/budgeting spreadsheets, news articles, testimonials, graphics, etc. If you plan events or offer a curriculum, please include event schedules and key curricular materials. 

Please save the document as "your full name -Materials"
- For example: "Albert Einstein - Materials"  

If file upload is rejected, confirm that you are uploading a .pdf filetype.
Additional Information

If not applicable, write N/A

If not applicable, write N/A

If not applicable, write N/A.

Choose all that apply.

All applicants must provide the names and contact information of three people who can speak to your project leadership. References may not be someone related to you. 

Please list the individuals after you have their permission. We MAY contact all or none, to provide a confidential reference.

Note: In some cases, staff may contact you or others familiar with your project for additional information.

All applicants are weighted equally, with or without a nomination.
Reference 1

Reference 2

Reference 3 (if not nominated)

Nominator (if nominated)

Miscellaneous Information
Your answers to questions in this section are for office use and will not be forwarded to the committee.

Demographics Information (Optional)
To address issues of diversity and representation, we are asking the following demographics questions for survey purposes only. This information will not be attached to your application and will be randomized for data collection only. 

Select all that apply.

Select all that apply.


By checking the boxes below, I confirm that, if selected as a recipient, I accept the following requirements:

You will receive a confirmation email upon submission. 
If you do not receive an email, please recheck that this form has no error alerts and contact us at 415-512-6432 before navigating away from this page.