Part 1
Name:
Surname:
Sex (F/M):
Date of Birth (dd/mm/yy):
Address (street,
number, city, zip)
Phone 1:
Phone 2:
Email:
Passport Number:
Passport Expiration Date:
Passport Issuing Country:
Name and number of a contact person in case of emergency:
Family Status (Single/Partnered/Married/Other):
Children:
Academic
and Professional Background
Occupation:
Place of work:
University/College:
Highest academic degree obtained:
Year of Graduation:
Do you have any formal or informal Jewish education? (Please
describe)
Languages
What is your level of Russian (rate
yourself on a scale of 1 to 5, where 1 is “not at all” and 5 is “excellent”)?
Speaking:
Reading:
Writing:
What is your level of English (rate
yourself on a scale of 1 to 5, where 1 is “not at all” and 5 is “excellent”)?
Speaking:
Reading:
Writing:
What other languages do you speak?
Part 2 - Jewish/Israeli
Involvement
Have you participated in Jewish Educational Activity before? (Yes/No):
If so, when, where and in which programs?
Have you ever been to Israel? (Yes/No):
If yes, how many times:
If yes, what was the purpose of your visit? (Family visit / tourism / volunteering/ work / other):
Do you have relatives living in Israel? (Yes/ No / Other):
Do you keep Kosher? (Yes / No/ Other):
Do you follow any special dietary? (Yes
– please specify / No):
What is your Jewish Affiliation:
- Secular
- Traditional- only Holidays
- Traditional – some Shabbat
- Reform
- Conservative
- Orthodox
What aspects of Jewish life do you connect with most strongly?
Part 3
Do you have any previous volunteer/community service experience?
Please describe.
What excites you most regarding the
opportunity to join the Mitbachon leadership trip? Please elaborate.
How you participation may contribute to the
Mitbachon leadership trip?
Thank you for your application!
The Mitbachon team.