Ohr Somayach /

Online application for Jewish Learning Exchange (JLE) and Shoresh Introductory Program.

This form is also available in PDF format. Click to download.

To apply on-line, please supply all information requested below. The application form can not be submitted until all questions with an asterisk * are answered.

We recommend that you print out a copy of your completed application before submitting.

If you encounter any problems while completing this application, please email us at apply-usa@ohr.edu or apply-canada@ohr.edu. Tell us your name and give a detailed description of the problem.

All personal information will be held in strictest confidence.

Program & Dates

*	You Are Applying from:
*	Preferred Dates:
		Select the tour you would like to join or "Shoresh" to apply for the ongoing Introductory Program

General Information

*	First Name:
	Middle Initial:
*	Last Name:
*	Date of Birth:	19
	Place of Birth:

School Information

*	University/College:
	If Not in List, enter here:
	What extracurricular activities, hobbies, personal interests or organizations occupy your time. Please briefly describe your participation in them: Please specify any awards, honors or scholarships you have received:

Employment Information

	Current (or most recent) Employer:
	Job Title:
	Primary Responsibility(s):
	If you have graduated but are not employed, what have you been doing since graduation?

Your Contact Information

*	Address 1:
	Address 2:
*	City:
*	State/Province:
*	Zip:
*	Phone Number:
*	E-mail:
	E-mail (alternate):

Permanent/Parents' Home Address

*	Residence of:
*	First Name:
*	Last Name:
*	Address 1:
	Address 2:
*	City:
*	State/Province:
*	Zip:
*	Phone Number:
	Fax:
	E-mail:
	E-mail (alternate):

Family Background

*	Father's First Name:
*	Father's Last Name:
*	Father's Occupation:
*	Mother's First Name:
*	Mother's Last Name:
*	Mother's Occupation:

Jewish Background

Do you identify as a member of the Jewish people?

Yes No

Current affiliation:

(Check all that Apply)

	Reform
	Conservative
	Orthodox
	Reconstructionist
	Non-denominational
	Unaffiliated

Were you born of a Jewish mother?

Yes No

Are any of your parents or grandparents converts?

Yes No

Have you been to Israel before?

Yes No

In What Context?

(Check all that Apply)

	Trip with Family or Friends
	Bar/Bat Mitzvah
	Teen Tour
	High School Program
	March of the Living
	Student Mission
	Semester/Year Abroad
	Traveled on My Own
	Birthright
	Yeshiva
	Essentials
	Jerusalem Fellowships
	Jewish Learning Exchange (JLE)

What types of Jewish experiences have you had?

(Check all that Apply)

	Jewish Summer Camp
	Jewish Youth Group
	Hebrew/Sunday School
	Bar/Bat Mitzvah training
	Jewish Day School/Yeshiva
	Judaic Studies/College Hebrew course
	Jewish Fraternity/Sorority
	March of the Living

Current Campus Involvement:

(Check all that Apply)

	Residence Association
	Greek Affiliation
	Student Government
	Campus Newspaper
	Intramural Sports
	Inter-collegiate sports
	Student Clubs
	Hillel
	Zionist
	Religious Denominational
	Jewish Cultural
	Jewish Student Association

Do you hold any leadership/professional positions on or off campus?

Yes No

Position:

Organization:

Special Requirements

*	Do you have any accessibility requirements or physical limitations or restrictions?	Yes No

*	Do you have any special dietary requirements?	Yes No
	If so, please elaborate.

*	Are you currently receiving medical treatment or professional counseling?	Yes No
	If so, please elaborate.

	If your are taking, or took in the past (on a protracted basis) any medication for any aspect of your health, please indicate:

References

	Please include name, address, phone, relationship to you. Please do not include family or friends.
	Reference:

Student Essay

Please tell us a little about yourself, in your own words. This will help us to assist you in selecting program options in sync with your needs and interests.
What interests you about the program to which you are applying?
Have you had any prior involvement with Jewish learning? Have you ever opened up a gemmarah? How do you relate to Judaism? Is there anything else you would like us to know about you?

Jewish Knowledge

	Little Familiarity	Basic Skills	Reading with Comprehension	Comments
* Hebrew Language
* Siddur / Daily Prayer Services
* Chumash / 5 Books of Moses
* Talmud

Submit Application:

Before submitting your application, please be sure that all information is complete and accurate.

We recommend that you print out a copy of your completed application before submitting.

If you encounter any problems while completing this application or do not receive e-mail confirmation of receipt of your application within one week of submission, please request confirmation, by e-mail, from apply-usa@ohr.edu or apply-canada@ohr.edu

A personal or telephone interview may be required of applicants.
The opportunity to be a part of any Ohr Somayach Program is conditional on adherence to the rules and regulations of the program. Ohr Somayach reserves the right to require the withdrawl of any student for any reason it deems sufficient.

Final acceptance on the trip is contingent on receiving your payment. If
you choose to withdraw from the trip after you have paid, you will be
reimbursed minus a $100 administrative fee

* I have read and agree to the Declaration of Understanding

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