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Hevruta Gap Year Application -- Part 1

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 two parts. The first will collect demographic information, as well as some short answer questions. The second part will ask for a photo, video, and contact information for your recommendation. Part 2 will also require a non-refundable $100 deposit. You must complete both parts of the form in order to be considered for the program.

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

hevrutagapyear@shalomhartman.org.

לטופס ההרשמה לתוכנית לישראלים לחצו כאן

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 Religious Education

Please rate your Hebrew skills:

If you're not currently enrolled in a Jewish day school, have you attended Jewish day school in the past?

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 in the past.

Previous Jewish Day School

Name of School:

Grades Attended:

Do you currently or have you previously attended Jewish Sunday school?

YesNo

Current or Previous Sunday 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 or training experiences in which you participated in high school. (100 word maximum)

Please describe any relevant volunteer experience in which you have participated, in or out of high school. (100-word maximum)

Have you participated in organized Jewish youth activities such as a Jewish youth movement, Jewish travel program, or other Jewish summer experiences? If so, please name and describe the program(s). (100-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.

Please share with us what Israel means to you.

In your opinion, what is the biggest challenge facing the Jewish people today?

If accepted, what do you expect to gain from participating in this program?

Thank you for completing Part 1 of the Hevruta application!

You will receive an email with a link to Part 2, in which you will be asked to upload a photo, video, and provide contact information for your recommendation.

You will also be asked to pay a $100 non-refundable application fee.

Salesforce IDs for participation records

Program ID - Insert Program ID here as DEFAULT VALUE

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.

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	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