First Name *

 

Last Name *

 

Street Address1 *

 

Street Address2

 

City *

 

State/Province Choose Option Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennyslvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Prince Edward Island Saskatchewan Ontario Quebec Yukon

 

Zip/Postal Code *

 

Country *

 

Home Phone Number *

 

Applicant’s Cell Phone Number

 

Applicant’s Email Address *

 

Date of Birth MM/DD/YY *

 

High School Graduation Year *

 

Gender * Choose OptionMaleFemale

 

How did you hear about Aardvark? *

 

 

I am applying for:

Year Program: $14,990

Semester Program - Fall 2010 $9,990

Semester Program - Spring 2011 $8,990

Semester Plus Program - January-July 2011 $9,990

First Semester Special Interest Program (please check one)

Digital Art and Media (Tel Aviv) ($1,499)

Law and Government (Jerusalem) ($1,499)

I am not registering for a special interest program first semester ($0)

 

Second Semester Special Interest Program (please check one)

Israeli Military (Jerusalem) ($1,999)

The Mind-Body Connection (Tel Aviv) ($1,499)

I am not registering for a special interest program second semester ($0)

 

Special Interest Weekend/Holiday Programs (must check one)

Shvil Yisrael (Israel Trail) ($2,999)

Kiruv (Spirituality) ($1,499)

I am not registering for a special interest weekend/holiday program ($0)

 

Am Yisrael World Travel Programs (please check all that apply)

Year Program Travel Package (Tunisia, Kenya, Bulgaria, Italy) ($10,396 )

Tunisia ($2,499)
Safari in Kenya ($3,499)
Ski in Bulgaria ($2,799)
Italy($2,799)

Mediterranean Cruise (June 2010) ($2,199)

Semester Plus Travel Package (Bulgaria, Italy, Mediterranean Cruise) ($7,297)

I am not registering for an Am Yisrael World Travel Program ($0)

 

Check Out Total: $0

 

 

Parent 1 First Name *

 

Parent 1 Last Name *

 

Address (if different from yours)

 

Home Phone Number (if different from yours)

 

Parent 1 Cell Phone Number

 

Parent 1 Work Phone Number

 

Parent 1 Email Address *

 

Parent 2 First Name *

 

Parent 2 Last Name *

 

Address (if different from yours)

 

Home Phone Number (if different from yours)

 

Parent 2 Cell Phone Number

 

Parent 2 Work Phone Number

 

Parent 2 Email Address *

 

If parents are divorced or separated, who has legal custody? MotherFatherJoint Custody

 

Sibling(s) Name(s)

 

Sibling(s) Age(s)

 

Religious Affiliation (example: Reform, Conservative, Orthodox, Reconstructionist, Unaffiliated, Secular)*

 

High School *

 

College/University attending (if any)

 

Camp(s) Attended

 

Youth Movement Affiliation

 

Have you been to Israel before? * YesNo

 

If yes, with what program or context?

 

Hebrew Ability:

Reading Ability * Choose Option PoorFairGoodExcellentFluent

 

Reading Comprehension * Choose OptionPoorFairGoodExcellentFluent

 

Speaking Ability * Choose OptionPoorFairGoodExcellentFluent

 

Listening Comprehension * Choose OptionPoorFairGoodExcellentFluent

 

Please list any interests, hobbies, or talents you have that may relate to volunteer work you’d like to do in Israel:

 

 

Please upload a recent photo of yourself. The photo should be a passport-style photo.

Upload Photo (Max size: 1000kb) Supported image Extensions (.png, .jpg, .bmp, .gif )

 

 

If you are not redirected to a new page after clicking "next" or "submit", please review your application and fill in any required fields you may have missed. On pages 2 and 3, you may need to use the "back" button at the bottom of the page to view a previous page of the application. For assistance, please call our office at the number below.