Rutgers Hillel Houston ASB 2019 Application
Join us in Houston from Sunday, March 17 - Friday, March 22. You can help Houstonians who are still recovering from Hurricane Harvey. Help rebuild homes, learn about racial and economic disparities in Houston, connect with Houston Hillel and celebrate Purim! $450 covers airfare, hotel and meals. You can make real difference this year! Application deadline is Friday, Feb 1!
First Name *
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Middle Initial
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Last Name *
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Current Street Address 1 *
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Current Street Address 2
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Current City Name *
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Current State Initials *
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Current Zip Code *
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Cell Phone # *
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Permanent Street Address 1 *
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Permanent Street Address 2
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Permanent City Name *
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Permanent State Initials *
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Permanent Zip Code *
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Current Email Address *
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Birthdate *
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Gender (I Identify as:) *
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Emergency Contact Information (Contact's Name, Home Address, Primary Phone Number, etc) *
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Do you have any allergies or limiting medical conditions? *
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Do you have any food allergies or dietary restrictions we should be aware of? *
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Is your Tetanus vaccine current? (Call your physician for records) *
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Health Insurance Policy and Number *
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Please share with us any special skills that you have that you would be willing to share with us on the trip
i.e. videography, photography, blogging, leading yoga, leading group activities, etc.
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Why are you interested in participating in the Hillel Alternative Spring Break? *
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Do you have any previous community service or volunteering experience? If so please describe. *
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What is one thing that you will bring to the group? *
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