APPLYING ON-LINE for the Aish Campus Boston Business Shabbos in NYC: Winter 2007

Please fill in all the required information (as denoted by *), otherwise your application will not be accepted.  After submitting this application you will automatically receive a confirming email.  Please notify us of any address or phone number changes at  jf@aish.com or call 1-845-425-8255 ext. 201

Program and Preferred Dates
*
Program Dates:  
General Information
* First Name:
* Last Name:
* Date of Birth:   (mm/dd/yyyy)
* Gender:
* How did you hear about the Program?

Please enter the name of the referring individual or organization, if applicable:
* Country of Birth:
College  Information
* Year of Graduation :
* University/College:
Major:
 

Employment Information (Mandatory if graduated)

Current Employer:
Job Title: 
Dates of Employment:
Previous Employer :
Job Title:
Dates of Employment:
What are your career or
educational plans for
the next year? Include
location if confirmed:
   
Your Contact Information
* Address:
* City:
* State/Province:
* Zip:
* Country:
* Phone Number: (###-###-####)
  Cell: (###-###-####)
  Work: (###-###-####)
  Fax: (###-###-####)
* E-mail:
     
* Your Marital Status: 
Permanent/Parents' Home Address
* Residence of:
* Address:
* City:
* State/Province:
* Zip:
* Country:
* Phone Number: (###-###-####)
  Fax: (###-###-####)
  E-mail:

Family Background

Mother's First Name:
Mother's Last Name
Mother's Occupation
*  Father's First Name:
Father's Last Name:
Father's Occupation
Parents' Marital Status:
*

Was your father born Jewish?

Please summarize conversion
history if any

  

*

Was your mother born Jewish?

Please summarize conversion
history if any:

  

*
Parents Jewish affiliation
  
*

Were all your grandparents born Jewish?

If no, please explain.

  



Educational History

  *  How many years of education (starting with first grade) completed?
     (i.e. 1st - 12th grade, plus 2 yrs of college would = 14)
*
What specific area or field of business are you interested in? :
  
 

Jewish Background

* What Jewish Education have you had?  
*
Your Current Jewish Affiliation:
  
 

Special Requirements

*
Do you have any accessibility requirements or physical limitations or restrictions?
  

 

If so, please elaborate.

  
*
Do you have any special dietary requirements? 
  
 
  If so, please elaborate.
  
*
Are you currently receiving medical treatment or psychological counseling?
  
 
If so, please elaborate
  

 

Have you received psychological counseling
in the past ?

  
 
If so, please elaborate:
  
*
Are you currently taking any medication?
  

       
If so, please elaborate. 
  
*
Have you ever been hospitalized?

     
If so, please elaborate.   
  

       
Personal Statement
* What do you hope to gain from this business Shabbos in NYC?