THE JERUSALEM FELLOWSHIPS

This application form must be completed by all those who seek admission to the Jerusalem Fellowships. Applications must include transcripts of all university study (which may be mailed separately) and a photograph. A $25 non-refundable application fee is required which can be made payable to "Jerusalem Fellowships."

Answers should be neatly hand written with a ball-point pen. All Applications will be reviewed by the Advisory Committee. Those applicants chosen for a personal interview will be notified of the time and location of the interview. All information will be held in strict confidence.

Please return this application to the following address, and indicate to which program(s) you are applying:

In the United States to:

The Jerusalem Fellowships, 28 Park Avenue, Airmont, NY  10952,
(800) FELLOWS (335-5697)
FAX:  708-570-3915

In Canada to:

The Jerusalem Fellowships, 949 Clark Avenue, West,  Thornhill, ON  L4J 8G
(416) 635-7530

[   ] Jerusalem Fellowships Summer/ Winter Break Program
[   ] Jerusalem Fellowships Internship For Leaders

Dates of preferred program _________________ 

(See www.goisrael.org homepage for program dates)              

In the United States to:

The Jerusalem Fellowships, 28 Park Avenue, Airmont, NY  10952,
(800) FELLOWS (335-5697)
FAX:  708-570-3915

In Canada to:

The Jerusalem Fellowships, 949 Clark Avenue, West,  Thornhill, ON  L4J 8G
(416) 635-7530

APPLICATION FOR ADMISSION

FULL NAME_____________________________________________________________M_____F ______

ADDRESS ____________________________________________________________________________

________________________PHONE (      )__________________PASSPORT# ______________________

SCHOOL_______________________________________________SOCIAL SECURITY # _____________

CURRENT YEAR IN SCHOOL____________________EMAIL ADDRESS _____________________

PERMANENT ADDRESS _________________________________________________________________

____________________________________PHONE (DAY)______________(EVENING) ______________

DATE OF BIRTH_____________________________________CITIZEN OF ________________________

MARITAL STATUS:   SINGLE_______MARRIED_______DIVORCED _______

FATHER'S NAME _____________________________________________________________________

HOME ADDRESS__________________________________________PHONE# _____________________

FATHER'S OCCUPATION___________________________________EMPLOYER ___________________

BUSINESS ADDRESS_______________________________________PHONE # ____________________

MOTHER'S NAME _____________________________________________________________________

HOME ADDRESS__________________________________________PHONE # ____________________

MOTHER'S OCCUPATION___________________________________EMPLOYER __________________

BUSINESS ADDRESS_______________________________________PHONE # ____________________

PARENT'S MARITAL STATUS:    MARRIED_____  SEPARATED/DIVORCED _______

ARE BOTH PARENTS BORN JEWISH?  YES___ NO ___  IF NOT, PLEASE EXPLAIN _______ ___________________________________________________________________________

PLEASE LIST ALL POST-SECONDARY SCHOOLS YOU HAVE ATTENDED OTHER THAN THE ONE PRESENTLY BEING ATTENDED.  ENTRIES SHOULD BE IN CHRONOLOGICAL ORDER, BEGINNING WITH THE MOST RECENT.

1. _________________________________________________________________________________

___________________________________________________________________________________

2. _________________________________________________________________________________

___________________________________________________________________________________

LIST ANY ACADEMIC HONORS OF OTHER DISTINCTIONS YOU HAVE RECEIVED SINCE THE NINTH GRADE        ______________________________________________________________________________

__________________________________________________________________________________
WHAT ARE YOUR PLANS FOR NEXT YEAR? INCLUDE LOCATION IF CONFIRMED ___________

___________________________________________________________________________________

WHAT ARE YOUR CAREER PLANS? _____________________________________________________

__________________________________________________________________________________

WHAT HAVE YOU DONE OVER THE PAST TWO SUMMERS? _________________________________

__________________________________________________________________________________

JOB HISTORY: (ENTRIES SHOULD BE IN CHRONOLOGICAL ORDER, BEGINNING WITH THE MOST RECENT.)

1. ________________________________________________________________DATE______________

2. ________________________________________________________________DATE______________

3. ________________________________________________________________DATE______________

DESCRIBE ANY LEADERSHIP/ACTIVIST ROLES YOU HAVE TAKEN OVER THE LAST FEW YEARS:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

 

IN WHAT OTHER EXTRACURRICULAR ACTIVITIES HAVE YOU BEEN INVOLVED OVER THE LAST FEW YEARS?  DESCRIBE YOUR PARTICIPATION:

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

HAVE YOU EVER BEEN TO ISRAEL? YES___ NO____ IF YES, WHEN AND IN WHAT CONTEXT?  

_______________________________________________________________________________________

PARENT'S RELIGIOUS AFFILIATIONS:   REFORM___ CONSERVATIVE ___ORTHODOX ___

OTHER___________ YOUR CURRENT AFFILIATION ________________________________________

DID YOU ATTEND HEBREW SCHOOL? YES____ NO____ IF YES, HOW LONG? _____________      

DO YOU FEEL YOU RECEIVED A COMPLETE JEWISH EDUCATION? YES______ NO______

ARE YOU, OR HAVE YOU BEEN,  A MEMBER OF A JEWISH ORGANIZATION? YES____ NO____

IF YES, PLEASE GIVE THE NAME AND POSITION HELD IF ANY:___________________________

_____________________________________________________________________________________

 

HOW DID YOU HEAR ABOUT THE JERUSALEM FELLOWSHIPS?  SPECIFY NAMES OF PERSONS AND/OR NEWSPAPERS                _________________________________________________________________________

 

DO YOU HAVE ANY SPECIAL MEDICAL NEED? YES_____  NO_____IF YES, PLEASE EXPLAIN

_____________________________________________________________________________________

ARE YOU ON ANY TYPE OF MEDICATION? YES_____ NO______ IF YES, PLEASE EXPLAIN

_____________________________________________________________________________________

DO YOU HAVE ANY SPECIAL DIETARY NEED? YES_____  NO_____IF YES, PLEASE EXPLAIN

_____________________________________________________________________________________

HAVE YOU EVER SOUGHT PSYCHOLOGICAL COUNSELING?   YES_______ NO_______

IF YES, PLEASE EXPLAIN _________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

REFERENCES

1.       NAME: ____________________________________________________________________________

ADDRESS: ____________________________________________________PHONE: (____)___________

2.       NAME: ____________________________________________________________________________

ADDRESS: ____________________________________________________PHONE: (____)___________

 

FINANCIAL ASSISTANCE

 

The full cost of the Jerusalem Fellowships is $4,000 US per candidate.  This includes round-trip airfare from New York, food, lodging, and cost of all programs.

Will you be requesting a scholarship?        [  ]YES        [  ]NO

If yes, please indicate the amount requested:  __________
(Note that the maximum scholarship available for the JFIL program is $3500 US.)

 

We sometimes offer additional scholarships to students/residents from certain geographical areas. 
(Please check with the Fellowships office to see if you are eligible for one of these scholarships. )

Additional Scholarship requested: ____________ (if eligible).

Please explain briefly why you are requesting the scholarship, and why it is needed.

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

 

SO THAT THE ADVISORY COMMITTEE CAN LEARN MORE ABOUT YOU, PLEASE SUBMIT A BRIEF ESSAY WITH YOUR APPLICATION ON THE FOLLOWING QUESTIONS (NO MORE THAN 2 PARAGRAPHS PER QUESTION):

 

A.      WHAT DO YOU HOPE TO GAIN FROM THE PROGRAM?  PLEASE BE SPECIFIC.

 

B.      WHAT IDEAS, LITERATURE AND PEOPLE HAVE HAD A PROFOUND EFFECT ON YOUR ATTITUDES AND IDEAS ON LIFE?

 

C.      WHAT DO YOU CONSIDER TO BE THE MOST CRITICAL ISSUE FACING THE JEWISH PEOPLE TODAY, AND WHY?  HOW WOULD YOU SOLVE THIS PROBLEM?

 (Answer the following question only if you are applying for the Jerusalem Fellowships Internship for Leaders)

D.     GIVEN A $100,000 BUDGET FOR JEWISH ACTIVISM ON YOUR CAMPUS -- HOW WOULD YOU BEST USE THE MONEY?

 

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