* First Name
| * Middle Initial
|
* Last Name
| * Hebrew Name
|
* Address
|
* City, State
| * Zip Code
|
* Permanent Address (if different)
|
* Phone (day)
| * Phone (night)
|
* Phone (mobile)
| * Phone at permanent address (if different)
|
* E-mail
|
* Marital status
|
Social Security
| * Date of Birth
|
* Were you ever in Israel?
Yes
No |
Dates of visit
|
Reason for visit
|
* Was your mother born Jewish?
Yes
No |
* Was your father born Jewish?
Yes
No |
If no, please explain
|
* Father's name
|
* Father's phone (day)
| * Father's phone (night)
|
* Father's Address
|
* City, State
| * Zip Code
|
* Mother's name
|
* Mother's phone (day)
| * Mother's phone (night)
|
* Mother's Address
|
* City, State
| * Zip Code
|
* Parents' marital status
|
Education |
* Present Occupation, if not attending college
|
Name of Employer (if applicable)
|
Brief Job Description:
|
List chronologically all the schools
you have attended:
Secondary Schools |
* Name of School
| * Location
|
* Dates of Attendance
| * Graduation Date and Degree Awarded
|
| College or University |
* Name of School
| * Location
|
* Dates of Attendance
| * Graduation Date and Degree Awarded
|
| Jewish Schools (if not included
in above) |
Name of School
| Location
|
Dates of Attendance
| Graduation Date and Degree Awarded
|
Hebrew language proficiency
* Read:
Not at all
Minimal
Average
Very well or fluent
* Speak:
Not at all
Minimal
Average
Very well or fluent
* Understand:
Not at all
Minimal
Average
Very well or fluent
|
| Have you ever studied (please check
all that apply): |
Bible
Hebrew Literature
Jewish History
Talmud
Other Judaic Study Matter |
If you checked any of the above subjects
above, what did the course consist of, and where did you take the
course?
|
Languages spoken at home
|
Activities and Organizations in which you have participated
|
AHave you or are you currently participating in the Moreshet Learning Fellowships?
|
* Are there any special characteristics of
your medical history that would affect your ability to participate
in the Program? If so please describe
|
* If you are taking, or took in the past (on a protracted basis)
any medication for any aspect of your health, please
indicate:
|
* Do you have any accessibility requirements or physical
limitations or restrictions?
|
| List two persons who can serve as
references for you: |
* Name 1
| * Phone 1
|
* Address 1
|
* Relationship to you 1
|
* Name 2
| * Phone 2
|
* Address 2
|
* Relationship to you 2
|
* How did you hear about the Moreshet Learning Retreats
|
Tuition Information |
Tuition for the Moreshet Learning Retreats Programs is
as follows:
$199.00 for individuals whose applications are received before December
7th
$250.00 for individuals whose applications are received after
December 7th
There is an additional $50.00 transportation fee for individuals
who will need Moreshet Learning Retreats to provide them with transportation
to and from the retreat location.
Tuition is due upon receipt of written (either hard copy or email)
acceptance to the program. We must be in receipt of your Tuition
money in order to guarantee your spot in the program.
Participants who received a scholarship, please refer to the information
package you received.
Financial Aid:
Scholarships are available for eligible applicants. Please be
in touch with Moreshet Learning Retreats at 800-927-0476 (or 866-268-7169
from Canada), or email
us to discuss scholarship options.
Refunds:
Cancellations received more that 1 month prior to the session
will be refunded in full, less a $100.00 cancellation fee.
Cancellations received less than one month before the session
are non- refundable.
Miscellaneous Information:
A personal interview may be required before final admission.
All personal information will be held in strictest confidence.
Moreshet Learning Retreats admits students of any race, color, national
and ethnic origin.
Any student not complying with program requirements during his
or her stay at Moreshet Learning Retreats may be asked to leave. In such
event, all fees would be refunded on a prorated basis.
|
* Please use the space below to write two paragraphs
describing what you hope to gain from the Moreshet Learning Retreats
program:
|
| By submitting this application online, I hereby affirm
that all of the information included in this application is correct
to the best of my knowledge, and that I have read and agree to the
terms and conditions of tuition payment. |
|
