Netivot Aliya 2021-2022 Application Form
General Information:
Applicant full Name *
Parents names , email and cell #:
Birthday
Email *
Address *
Cell phone number *
High school (current and former if applicable)
Current institution of learning (if post high school)
Year made Aliya or date planning to make Aliya
City/Country made Aliya from
Did you make aliya ?
Clear selection
How did you hear about Netivot Aliya?
About you:
How are your Hebrew language skills?
Clear selection
Have you ever had a job? Please elaborate
Will you have graduated High school after this year?
Clear selection
Special Requirements
Do you have any physical limitations or restrictions?
Clear selection
Are you currently taking medication? If so, please elaborate.
Do you have any allergies or special dietary requirements? If so, please elaborate.
Are you currently receiving medical treatment or psychological counseling? If so, please elaborate.
Why do you want to be in this program?
The extras: what interests you? Check all that apply:
Is there anything else you would like to see in this program:
Netivot Aliya is partially funded through Aminadav but we rely on donations to fund our extra services. Tution for the year is 1000$US or 4000NIS. Scholarships are available for any girl that is not able to pay. This is a non profit program and all money goes directly to program expenses. Tax receipts can be given (US or Israel) .
Clear selection
Reference:
someone who knows you: teacher, principal, rabbi, etc.
name:
contact info:
relationship to you:
Thank you for completing the application! We will be in touch with you soon! We will also be doing personal interviews in person or by phone.
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