Aish Olami Winter Break Poland Trip
Thank you for your interest in the Poland Trip. Please provide some basic information below to start the application process. An interview is required for all qualified applicants, and upon being accepted to the trip, a $200 non-refundable deposit is required.

By submitting this application you are certifying that everything you have filled out is true to the best of your knowledge. False and/or misleading information may result in the applicant being responsible to pay the full value of the trip ($3,000).

First Name *
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Last Name *
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Phone Number *
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Email *
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Date the world could no longer exist without you... (birth) *
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DD
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YYYY
Year *
Full Name on Passport
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Passport number *
Your answer
Passport Expiration date *
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YYYY
Father's First Name *
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Father's Last Name *
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Mother's First Name *
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Mother's Last Name *
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Just how Jew are you? (check all that apply) *
Required
Please list any extracurricular activities in which you are involved
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Do you currently have, or did you have in the past, any special health needs about which we should be aware? *
If yes please explain
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Do you have any special dietary requirements? *
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Please state your reasons for wanting to attend the Poland trip *
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How did you hear about the trip? *
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