LAJ - LA Jewish Experience
 

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First Name
Last Name
Date of Birth
Country of Birth
Gender
Street
City
State
Zip
Cell Phone
() -
Home Phone
() -
Email
Martial Status
Mother's Name
Father's Name
What is your current Jewish affiliation?
Was your mother born Jewish?
Was your father born Jewish?
Are you a convert to Judaism?
Are you a full-time student?
High School Attended
Year of Graduation
Undergraduate University/College Attended
Undergraduate Major
Year of Graduation/Projected Graduation
Employment Status
Position
Name of Employer
Street
City
State
Zip

Which Jewish educational programs have you participated in before? (if any)
Have you participated in a Birthright trip to Israel?
Have you ever participated in any Jewish educational trips (other then Birthright)?
Do you know how to read Hebrew?
Have you ever attended a Jewish School?
How many years did you attend?
Which grades?
List any groups, clubs, or fraternities/sororities you belong to
How did you hear about the program?
Briefly explain what you hope to gain from the LA Jewish Experience - Israel Trip
Please select a date for interview and FREE Sushi info session