NCSY Alumni Shabbaton

Please fill in all the information; otherwise, your application will not be processed. Call Alizza @ 1.800.742.2228 with any questions.

NCSY Alumni Shabbaton Application Form

General information

Your Name:

Date of Birth:

Gender Male Female

How did you hear about the Program?

Country of Birth?

Current Occupation?

Employer?

Home phone?

Work phone?

Cell phone?

Please attach a picture of yourself here

School Information

Current School Status: Freshman Junior Sophomore Senior Graduated/Other

University/College Currently Attending

High School Attended

Have you ever learned in Israel before? Yes No

Your Contact Information

Address:

City

State/Province

Postal Code

Country

Phone Number

Your Current Jewish Affiliation: Reform Conservative Orthodox Unaffiliated
Recently becoming observant Other systems explored or observing

Housing Information

Do you have any Friends applying for this trip? Yes No

Please name anyone you'd like to house with:

Special Requirements

Do you have any accessibility requirements or physical limitations or restrictions? Yes No

Please elaborate:

Do you have any special dietary requirements? Yes No

Please elaborate:

Are you currently receiving medical treatment or psychological counseling? Yes No

Please elaborate:

Are you currently taking any medication? Yes No

Please elaborate:

Have you ever been hospitalized? Yes No

Please elaborate: