JWSA Pilot Trip Application
Name
Date of Birth
School
Home Address
School Address
Phone
E-mail

Family Information

Father's Name
Mother's Name
What's your father's occupation?
What's your mother's occupation?
Parents Marital Status
Is your mother born Jewish?
Is your father born Jewish?
Where were your parents born?

Miscellaneous Information

Have you ever been to Israel before?
If so, in what context?
Do you have any “formal’” Jewish Education? If so, please list the Jewish schools you attended together with the dates
How did you hear about this trip, or who referred you?
Are you or have you been, a member of a Jewish organization? If so, which one.
Describe your Jewish observance:
Do you have any special medical need?