Israel 2.0 Poland Application- Summer 2019

POLAND APPLICATION

Please complete this short questionaire. Once submitted, we will forward you the official application and proceed to schedule an interview.
Name
First Last
Phone
Email
Occupation/Student Status
Date of Birth
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Religious Affiliation
Was your mother born Jewish?
Was your father born Jewish?
Were your grandparents born Jewish?
How did you hear about our program?
Why do you want to go to Poland? (Please limit answer to a short paragraph.)
Phone
This field is for validation purposes and should be left unchanged.