Apply for The JGSI Fellowship

General Information

Name*

First Last

Email Address*

Hebrew Name

Mother's Hebrew Name

Date of Birth (mm/dd/yyyy)*

Gender*

Male
Female

How did you hear about the program?

Please enter the name of the referring individual or organization if applicable:

Country of Citizenship

School Information

Year of Graduation*

School*

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 next year? Include location if confirmed

Contact Information

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone*

Work Phone

Marital Status

Parents' Information

First and Last Names Street Address City / State / Zip Phone Number Email Address Country

Was your father born Jewish?*

Yes
No

Was your mother born Jewish?*

Yes
No

Parents' Jewish Affiliation*

Were all your grandparents born Jewish?*

Yes
No

If no, please explain:

Educational History

What extracurricular activities, hobbies and organizations are you involved in? Please describe your participation in them:

Jewish Background

What Jewish education have you had?*

If you attended Hebrew School, how many years did you attend?

What was the Jewish affiliation of your Hebrew School?

If you attended Jewish Day School, how many years did you attend?

What was the Jewish affiliation of your Day School?

Your current Jewish affiliation:*

How would you describe your Hebrew reading skills?

Do you hold any leadership/professional positions in Jewish organizations?

If so, what position?

Have you ever been to Israel?*

Yes
No

If so, in what context? (Bar/Bat Mitzvah, year abroad, March of the Living, Birthright Israel, Yeshiva study, etc.)

What types of Jewish experiences have you had? (Bar Mitzvah, youth group, fraternity/sorority, etc.)*

My top 4 priorities in life are:*