Registration Form
Personal Information
Basic Information
First Name
Last Name
Birthdate
Gender
Male
Female
Other
Please specify any dietary restrictions that you have
Vegetarian (Do eat dairy and eggs)
Vegan (No animal products)
Dairy intolerant
Wheat intolerant
Other limitations
Please elaborate
Contact Information
Personal email
Mobile
Home Phone
Work Phone
Address
Zip
City
Country
Please select...
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
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Aruba
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Austria
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Bangladesh
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Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
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Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos ( Keeling ) Islands
Colombia
Comoros
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Cook Islands
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Côte d ' Ivoire
Croatia ( Hrvatska )
Cuba
Cyprus
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Congo ( DRC )
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
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Ethiopia
Falkland Islands ( Islas Malvinas )
Faroe Islands
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Finland
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French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia
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Germany
Ghana
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Israel
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Madagascar
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Mayotte
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Nigeria
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Paraguay
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Pitcairn Islands
Poland
Portugal
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Reunion
Romania
Russia
Rwanda
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Saudi Arabia
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Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
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Spain
Sri Lanka
St. Helena
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Sudan
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Sweden
Switzerland
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Tanzania
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Uruguay
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State
Please select...
Alabama
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District Of Columbia
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Texas
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Vermont
Virginia
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Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
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Education & Community Service Information
Education
High School
Course of Study
Community Involvement
Have you ever been involved in a Youth Movement / Youth Club / Organisation?
Yes
No
Please list all organisation(s) which you have belonged to, or still belong to which you think would be useful for us to know about (e.g.: school, synagogue, club, committee) and in what position / capacity
Do you have any particular talents / interests / hobbies which would be appropriate for / relevant to volunteering in a community?
Yes
No
Please elaborate
Languages
Hebrew Knowledge
Are you familiar with the Hebrew alphabet?
Yes
No
Are you able to read Hebrew without vowels?
Yes
No
Have you ever studied Hebrew grammar formally?
Yes
No
For how long and in what framework?
How many words are in your Hebrew vocabulary?
Please select...
none
10-50 words
50-200 words
200-300 words
more than 300 words
Please mark the level of your Hebrew for each category
Reading ability
Please select...
Don't know
Poor
Fair
Good
Excellent
Reading comprehension
Please select...
Don't know
Poor
Fair
Good
Excellent
Speaking ability
Please select...
Don't know
Poor
Fair
Good
Excellent
Ability to understand a conversation
Please select...
Don't know
Poor
Fair
Good
Excellent
Other Languages
Do you know another language?
Yes
No
Please mark the level in each option
language list
Don't know
Poor
Fair
Good
Excellent
french
Russian
Spanish
Do you know another language that isn't on this list?
Yes
No
other language
Which other language
The level of this language
Please select...
Poor
Fair
Good
Excellent
Israel Connections
Have you been to Israel before?
Yes
No
Describe when and in which arrangment
Visit with Family
To study
Volunteer
With an organized program / youth movement
Year Course
Travel with friends
Other
Please specify
Please give additional information (dates, tour organizer, program, length of stay)
Please specify: how many times you have been to Israel, have you ever lived in Israel and for how long, what is the longest single period you have been to Israel
Are either of your parents Israeli?
Yes
No
Which parent(s)?
Please select...
Mother
Father
Both
Do you have an Israeli identity card or an Israeli identity number?
Yes
No
Israeli identity number
Do you have relatives/friends in Israel?
Yes
No
Friends
Name
Email
Phone
Address
City
Are you Jewish?
Yes
No
I consider myself to be
Please select...
Secular
Traditional
An observant religious Jew
Orthodox
Other
Please specify
Do you keep Kosher?
Yes
No
Please specify at what level?
Please select...
strictly
eat non-kosher meat but no pig products
eat non-kosher meat but no pig products or shellfish
kosher at home but not out
other
Please specify
Do you keep the Shabbat?
Yes
No
Please specify at what level
Please select...
strictly
don't use electricity
don't travel
other
Please specify