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Dating & Marriage

Online application for JEWISH LEADERSHIP HARMONY CENTER

We recommend that you print out a copy of your completed application before submitting. If you encounter any problems while completing this application,
please email us at alvin26@017.net.il Tell us your name and give a detailed description of the problem. All personal information will be held in strictest confidence.

Pogram & Dates
You Are Applying from:
Preferred Dates:
General Information
First Name:
Middle Initial:
Last Name:
Date of Birth: 19
Place of Birth:
School Information

University/College:
If Not in List, enter here:
What extracurricular activities, hobbies, personal interests or organizations occupy your time. Please briefly describe your participation in them:

Please specify any awards, honors or scholarships you have received:

Employment Information
Current (or most recent) Employer:
Job Title:
Primary Responsibility(s):
If you have graduated but are not employed, what have you been doing since graduation?
Your Contact Information
Address 1:
Address 2:
City:
State/Province:
Zip:
Phone Number:
E-mail:
E-mail (alternate):
Permanent / Parents' Home Address
Residence of:
First Name:
Last Name:
Address 1:
Address 2:
City:
State/Province
Country:
Zip:
Phone Number:
Fax:
E-mail:
E-mail (alternate):
Family Background
Father's First Name:
Father's Last Name:
Father's Occupation:
Mother's First Name:
Mother's Last Name:
Mother's Occupation:    
Jewish Background
Do you identify as a member of the Jewish people? Yes No
Current affiliation:
(Check all that Apply)
Reform
Conservative
Orthodox
Reconstructionist
Non-denominational
Unaffiliated
Were you born of a Jewish mother? Yes No
Are any of your parents or grandparents converts? Yes No
Have you been to Israel before? Yes No
In What Context?
(Check all that Apply)
Trip with Family or Friends
Bar/Bat Mitzvah
Teen Tour
High School Program
March of the Living
Student Mission
Semester/Year Abroad
Traveled on My Own
Birthright
Yeshiva
Essentials
Jerusalem Fellowships
What types of Jewish experiences have you had? (Check all that Apply) Jewish Summer Camp
Jewish Youth Group
Hebrew/Sunday School
Bar/Bat Mitzvah training
Jewish Day School/Yeshiva
Judaic Studies/College Hebrew course
Jewish Fraternity/Sorority
March of the Living
Current Campus Involvement: (Check all that Apply) Residence Association
Greek Affiliation
Student Government
Campus Newspaper
Intramural Sports
Inter-collegiate sports
Student Clubs
Hillel
Zionist
Religious Denominational
Jewish Cultural
Jewish Student Association
Do you hold any leadership/professional positions on or off campus? Yes No
Position:
Organization:
Special Requirements
Do you have any accessibility requirements or physical limitations or restrictions? Yes No
Do you have any special dietary requirements? Yes No
If so, please elaborate.
Are you currently receiving medical treatment or professional counseling? Yes No
If so, please elaborate.
If your are taking, or took in the past (on a protracted basis) any medication for any aspect of your health, please indicate:
References
Please include name, address, phone, relationship to you. Please do not include family or friends.
Student Essay
Please tell us a little about yourself, in your own words. This will help us to assist you in selecting program options in sync with your needs and interests. What interests you about the program to which you are applying? Have you had any prior involvement with Jewish learning? Have you ever opened up a gemmarah? How do you relate to Judaism? Is there anything else you would like us to know about you?
Jewish Knowledge
 
Little Familiarity
Basic Skills
Reading with Comprehension
Comments
Hebrew Language
Siddur / Daily Prayer Services
Chumash / 5 Books of Moses
Talmud
Submit Application:

Before submitting your application, please be sure that all information is complete and accurate.

We recommend that you print out a copy of your completed application before submitting.

If you encounter any problems while completing this application or do not receive e-mail confirmation of receipt of your application within one week of submission, please request confirmation, by e-mail, from alvin26@017.net.il

A personal or telephone interview may be required of applicants.
The opportunity to be a part of any JLHC Program is conditional on adherence to the rules and regulations of the program. Ohr Somayach reserves the right to require the withdrawl of any student for any reason it deems sufficient.

Final acceptance on the trip is contingent on receiving your payment. If
you choose to withdraw from the trip after you have paid, you will be
reimbursed minus a $100 administrative fee

Declaration of Understanding
 
 

ISRAEL: Direct : 011-972-544-917-257
011-972-77-67 -67-5-67
011-972-72-22-12-14-12

P.O. Box:27016 Jerusalem 91270

USA: Los Angeles: 310-655-7000
Direct L.A. : 310-909-8859
New York :516-6849722

P.O. Box :260001 Encino CA .91426-0001

E.MAIL: Send