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Hevruta Gap Year Application

Thank you for your interest in the Shalom Hartman Institute's Hevruta Gap Year Program! We are excited to get to know you. If you have any questions during your application process, please send us an email at hevrutagapyear@shalomhartman.org.

Please be advised that this form has several parts. You are asked to provide demographic information, answer several short answer questions, and to submit a photo, video, and contact information for your recommendation.

There is a non-refundable $100 deposit to apply and you must complete all parts of the form in order to be interviewed for the program.

You can save at any point and complete the form later.

If you are having difficulty submitting this form, or have any questions regarding the application process, please contact us at

hevrutagapyear@shalomhartman.org.

Personal Information

First Name

Last Name

Please specify your birthdate (MM/DD/YYYY):

Gender Identity:

Pronouns

Gender Identity:

Pronouns:

Personal Email Address:

Home Phone Number:

Mobile Phone Number:

Mailing Address

Country

City

State

Provinces

Postal Code

Geographic Region

Family Information

Please provide information about your parents or legal guardians.

Parent or Guardian #1

First Name:

Last Name:

Relationship to Applicant:

Mother

Father

Other

Please Elaborate:

Email Address:

Mobile Phone Number:

Occupation:

We require information about both parents or legal guardians.

Click here to provide details on a second parent or legal guardian.I do not have a second parent or legal guardian.

Parent or Guardian #2

First Name:

Last Name:

Relationship to Applicant:

Mother

Father

Other

Please Elaborate:

Email Address:

Mobile Phone Number:

Occupation:

Educational Information

Please select your school from the list below.

If you are home schooled, please select the "Homeschooled" option.
If you do not see your school on this list, please select the option "I don't see my school on this list," and check the box below.

High School Name:

School Account ID

I don't see my school on the list.

School Information

Name of School:

Country

Mailing Address

City

State

Provinces

State/Province

Postal Code

Geographic Region

Hebrew and Jewish Education

Please rate your Hebrew language skills:

Have you attended Jewish day school?

I am currently enrolled in a Jewish day school.I have attended Jewish day school in the past.I have not attended Jewish day school.

Previous Jewish Day School

Name of School:

Grades Attended:

Do you currently attend, or have you previously attended, religious/Hebrew/congregational school?

YesNo

Current or Previous religious/congregational School

Name of School/Synagogue:

Grades Attended:

Have you ever attended a Jewish Summer Camp?

YesNo

Current or Previous Jewish Summer Camp

Name of Camp:

Grades Attended:

Does your family belong to a synagogue or congregation?

YesNo

Synagogue or Congregation Info:

Name of Synagogue:

Are you involvolved in your synagogue? If yes, please describe:

Extracurricular Activities

Please describe any relevant leadership positions you have held while in high school. (100 word maximum)

Please describe any relevant volunteer experiences you participated in during high school. (100-word maximum)

Hevruta is looking for students who are 1) deeply engaged in Jewish life, 2) who have questions about the Jewish world and are committed to exploring those questions and 3) who thrive in community and academic settings. Which of these 3 elements do you feel is currently your strongest and how does it appear in your life? Which of the 3 elements are you looking to further develop and why? (250-word maximum)

Please share what you like doing in your spare time. This could be hobbies, interests and other. (100-word maximum)

Personal Viewpoints

Please respond to the questions below in no more then 500 words each. There are no right or wrong answers, just different perspectives.

Describe your relationship with Israel: When has that relationship been most challenging and when has it been most meaningful?

What do you see as the most pressing challenge facing the Jewish people today and what contributes to it? Where do you see opportunities to make an improvement?

If accepted, what do you expect to gain from participating in Hevruta - and how do you see that manifesting in your life as a Jewish leader in college and beyond?

Recommendation

Recommendation - High School Teacher, Rabbi, Educator, etc.

Please share information of a person you would like us to contact on your behalf, who is able to speak to your eligibility for the program. Examples of recommenders can be: a high school teacher, Rabbi, Jewish educator, or someone else who knows you well, not including family members.

Title

First Name

Last Name

Other Title

Recommender's Email

Photo

Please upload a photo of yourself facing the camera.

Introduction Video

Please add a link to a short video of no more than 60 seconds describing a day in your life. The video should feature yourself talking to the camera for a reasonable amount of time. Please make sure the link video is not private so we can access it. If you are having trouble sharing a video with us, please see the attached guidelines.

Payment Information

There is a $100, non-refundable, application fee. Your credit card information will not be saved/stored. Credit card will be charged by "Stripe"

Card Number

Name on Card

Cardholder's Email Address

CVV

This form may take take a few minutes to process. Please be patient and stay on the page until you see the confirmation that the form submission has been completed.

Salesforce IDs for participation records

Program ID - Insert Program ID here as DEFAULT VALUE

Save my progress and resume later | Resume a previously saved form

	None	Some	Very Good	Fluent
Proficiency in READING
Proficiency in WRITING
Proficiency in SPEAKING

Reform	Conservative	Orthodox
Reconstructionist	Renewal	Traditional
Secular	Non-denominational	Just Jewish
Other

High School Teacher	High School Principal	Guidance Counselor
Other Educator	Rabbi or Clergy Member	Other