(icnext) 2017-19 Participant Application Form
Email address *
Part I
Name: *
Your answer
Address *
Your answer
Phone (Cell): *
Your answer
Email: *
Your answer
Parents' Name: *
Your answer
Parents' Phones (Cells and Works): *
Your answer
Parents' Emails: *
Your answer
School: *
Your answer
Synagogue (if a member): *
Your answer
Date of Birth: *
High School Graduation year: *
Your answer
List your extracurricular activities. Include and describe your participation in pro-Israel activities in your community, at your school, youth group or synagogue (use additional page if necessary): *
Your answer
Have you been to Israel before? If yes, when and with whom? *
Your answer
Please list 2 references, one academic and one personal (name, e-mail and phone for each): *
Your answer
Are you currently writing for your school or community newspaper? If so, please email us ( a sample:
Your answer
Part II
We will conduct personal interviews in August, 2017. Please look at the prompts below. During your interview, we will discuss them.
Prompt #1: Tell us about an event in your life and your response to it that closely reflects who you are as a person. If possible, relate that event to your being Jewish or to Israel.

Prompt #2: Choose from one of the following topics (you can use the Internet, newspapers or books to familiarize yourself with the topic):

1. A new government is now in place in Israel. As a citizen of Israel you write a letter to the editor of your favorite Israeli paper indicating the three top issues you want your government to focus on while in office. Explain why these are important and what you hope the outcome will be.

2. Your college campus is planning to host Israel Apartheid Week next March. You are planning a counter event and are applying to the university for funds to put that event on. First, explain Israel Apartheid Week. Then describe what your counter event will consist of and what you hope it will accomplish.

Additional Information
Program cost:
Total program cost is $1800.00 for both years including the Israel trip. Significant funding from the Jewish Federation of Cleveland underwrites the cost of seminars and travel.
Gift of Israel saving can be applied to the cost. Financial aid is available. ******************************************************************************************* Application process:
 Applications for Cohort 6 are now being accepted. Send completed application and essays to:@akiva, 26500 Shaker Blvd., Cleveland, OH 44122.
 Personal interviews will be conducted during August of 2017. ******************************************************************************************* Note: Due to program scheduling conflicts, students cannot participate in both and The Saltzman Youth Panel during their junior year. *******************************************************************************************
Never submit passwords through Google Forms.
This form was created inside of Jewish Education Center of Cleveland. Report Abuse - Terms of Service - Additional Terms