Aish Olami Winter Break Poland Journey
Thank you for your interest in the Poland Trip. Help us get you started on your application by providing some basic information below. 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 ($2,400).
First Name *
Last Name *
Phone Number *
School Email
Other Email *
School
Clear selection
Date of Birth *
MM
/
DD
/
YYYY
Full Name on Passport (can submit passport info later)
Passport Number
Passport Expiration Date
Father's First Name *
Father's Last Name *
Mother's First Name *
Mother's Last Name *
Is your father Jewish? *
Is your mother Jewish? *
With which religion do you most associate? *
Please list any extracurricular activities with which you are involved. *
Do you currently have, or did you have in the past, have any special health needs about which we should be aware? *
If yes, please explain.
Do you have any special dietary requirements? *
If you answered 'other' above, please elaborate
Emergency Contact Name *
Emergency Contact Email *
Emergency Contact Phone Number *
Please state your reasons for wanting to attend the Poland trip. *
How did you hear about the trip? *
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