GEM Israel Trips Application

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Thank you for applying to GEM Israel Trips.
Important: When done, CLICK ON "Submit" at the end.
(Then you'll see a confirmation message at the top of your screen.)

First Name *

Last Name *

Email address we should use. *

My Home Street Address *

City *

State/Province *

Country *

Click on all boxes that apply to you. *

I am a Jewish female and more than 29 years old.

My natural mother was born Jewish.

I speak English fluently.

I am able to walk without difficulty.

I am married to a Jew.

I have children.

I have at least 1 child growing in Torah observance.

I have at least 1 child in college/university.

I have grandchildren.

I have close family or friends living in Israel.

I have been to Israel at least once.

I have special dietary requirements.

I am currently taking medication.

I have allergies.

I am currently receiving medical treatment.

I am receiving treatment for a psych disorder.

Aish Ha Torah has contributed to my growth.

I am interested in the GEM 14 Trip, October 22 - 31, 2012. (Apply by Aug 26)

Other:

Required

Zip Code *

List phone numbers: Home first, then Cell. *

Put * before the one we should use.

Best days & times to reach you for a phone interview *

(excluding Fri & Sat). We'll be calling from Israel which is 7 hours ahead of NY time.

What do you hope to gain from joining a GEM Trip? *

Date of Birth * mm/dd/yyyy *

Marital Status *

single, never married

married

divorced

separated

widowed

Other:

Your Current Employer & Job Title *

Husband's Employer & Job Title

Names & Ages of children & grandchildren

name - age Put each child/grandchild on a new line

List dietary needs, allergies, meds & treatment *

What activities, hobbies or sports do you enjoy?

What is/was your parents' Jewish affiliation? *

Reform

Conservative

Orthodox

Ba'alei Teshuvah

Unaffiliated but Jewish

not Jewish

Other:

What Jewish education have you had? *

Virtually none

Hebrew school/Sunday school up to age 13

Hebrew school/Sunday school after age 13

Jewish Day School

Yeshivah High School

Other:

What is your current affiliation? *

Reform

Conservative

Orthodox

Ba'alas Teshuuva

Unaffiliated but Jewish

Other Jewish systems explored or observing

not Jewish

Convert to Judaism, Orthodox

Convert to Judaism, not Orthodox

Other:

Hebrew reading skills *

(You don't need them to come on GEM.)

Not able to read at all.

Introductory

Intermediate

Advanced

Other:

Congregation & Rabbi

Names, City of congregation, Rabbi's email

Reference *

Name, Email, Relationship (prefer not family)

Second Reference

Name, Email, Relationship

Emergency Contact Information *

Full name, phone numbers, email, relationship

How did you hear about GEM Israel Trips? *

Click on all boxes of all that apply to you.

From a GEM Israel Trip participant

From someone learning/learned at Aish, EYAHT or JEWEL

From someone learning/learned at a different Israel school

From a friend or acquaintance

From someone at an Aish Branch

From an Aish rabbi or rebbetzin

From a GEM Israel Trip promotional postcard

From a newspaper or magazine article

From a sign/flyer at school, shul, JCC or elsewhere

From an announcement at shul or group meeting

I occasionally/often visit aish.com. While there, learned about GEM.

From an internet search

From a promotional email about GEM Israel Trips

From Facebook

From GEM staff

From a son or daughter

From a relative other than son or daughter

Other:

Required

Anything you would like to add?

Submit

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