Y.E.S. Application Form
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Application for Y.E.S. Yeshiva Experience @ Shapell's - Summer-2011 June 13, 2011 - July 3, 2011 || July 5, 2011- July 24, 2011
Instructions: All applications must be filled out completely. On completion, please submit this form (by clicking on the submit button at the bottom of the page), and send us two letters of recommendation and a digital photograph to our Israel office. [Please read this first to ensure a successful application: --The form might not work for older browsers, but you can print out the form, fill it in, and fax or mail it to the Darche Noam Israel office. --If you want to cut and paste the form to a word processing program and send it to us as an attached file, please do not type the answers into the text boxes. It becomes difficult to process the application. --It is probably a good idea to save your essay (question 22) separately before submitting. --If your essay (question 22) is particularly long, send it separately as an e-mail; the online form takes only a limited number of characters.]
If you don't want to apply online, you can also apply by:
Online Application Form:
1. Applicant's Name:
Last
First
Middle
Hebrew
Street and Number
City
State
ZIP
Telephone #
Cellphone #
Email Address
Birth Date (day/month/year)
Place of Birth
Citizenship
Yes No
Were you ever on a Yeshiva, Birthright, Post-Birthright, or similar trip to Israel?
Father's Name
Place of birth
Mother's First & Maiden Name
Father's address
Home phone
Mother's address (if not same as father's)
Father's Occupation
Name of Business
Mother's Occupation
13. My knowledge of Hebrew is:
Reading
Writing
Speaking
Understanding
14. If time has elapsed since you last attended school, describe how that time has been spent (if you've been employed please give name of company or employer.)
15. What are your vocational goals?
16. Activities and organizations in which you have participated, and in what capacity
17. Hobbies, including artistic skills
B. Are you presently undergoing treatment or taking medication for any illness or condition (physical or emotional) not described above?
If yes, please explain: 19. Do you have any special dietary requirements?
20. Were you interviewed by a member of the Darche Noam staff? Who? When?
21. Emergency contacts:
In case of emergency please contact:
A. In Israel, Name
Address
Phone
Relationship
B. In Native Country, Name
All inclusive fees for this program is US $649, including airfare from NY, or $299 with a Maimonides II Voucher. Full payment of $649 or $299 is due immediately upon acceptance. This payment is non-refundable. (These fees are subject to periodic adjustments.) The applicant agrees to abide by the rules and regulations set by Darché Noam for the health, safety and welfare of the students.
I understand that Darché Noam/Shapell’s, while it takes precautions to eliminate the risk of loss or damage to applicant's personal property, is not held financially responsible if such loss or damage should occur. I understand that I am required to participate fully in all activities making up this program.
I certify that the information given in this application is complete and correct.
Signature of Applicant Date
Please ensure that your application is fully completed, including photograph, essay, and letter of recommendation. No decision can be made until all materials are received.
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