FORM DUE April 15, 2023

Flight Itinerary

Camp Counselor iEngage Seminar

May 15 -- May 21, 2023

Welcome!

Welcome! We are so excited that you are attending the Camp Counselor iEngage Student Seminar taking place in Jerusalem. The group will staying at the Dan Panorama Hotel.

Programming will begin on Monday, May 15 at 3pm @ Shalom Hartman Institute.
Programming will conclude on Sunday, May 21 at 6pm @ Shalom Hartman Institute.

Please submit your itinerary information in the form below.

Questions
Please contact Gabe Pont (gabe.pont@shalomhartman.org).

Personal Details

First Name

Last Name

Itinerary Information

PDF of your travel itinerary

Departing Flight

Departing Airport

Departure Date

Flight Number

Departure Time (Local to Departure Location)

Please enter the time in this format: XX:XX AM/PM

Arrival Date in Israel

Arrival Time

Please enter the time in this format: XX:XX AM/PM

Return Flight

Departure Date from Israel

Flight Number

Departure Time

Please enter the time in this format: XX:XX AM/PM

Reimbursement Information

All participants on this program will receive a $600 stipend to assist with the costs of travel. The process of reimbursement will start after you complete this form. You can expect to receive the payment to your account 10-15 days after submitting the form.

Choose one option

Input Bank InformationUpload Photo of a Voided check

In lieu of inputting information, feel free to upload a voided check, but please confirm with your bank that the routing number on the check can be used for ACH transactions

Bank Information

Name of account holder

Account Number

Country

Financial Institution's Name

Routing Number