* All weekday Interviews begin at 7:30 PM, Sundays - 5 PM
WHERE: RAJE - 2915 Ocean Parkway - Moadon Room on the Ground Floor

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Application for The RAJE Leadership Fellowship

Spring 2012.

Questions marked with a * are required.

General Information
*1. First Name
*2. Last Name
*3. Please choose a date to come in for the interview (first come - first served basis)
WHERE: 2915 Ocean Parkway, Social Hall "Moadon", ground floor:
4. Work phone
*5. Home Phone
*6. Cell phone
*7. E-mail
*8. Date of Birth (mm/dd/yyyy)
*9. Gender
*10. Country of birth
11. If you were not born in the US, year of arrival in to the US:
*12. City of birth
13. School Status
Full-time student (12 or more credits)
Non-full time student (under 12 credits per semester)
*14. Address
*15. City
*16. State
*17. Zip
Family Background
*18. Marital status
19. If married, name of your spouse
*20. Mother's First Name
*21. Mother's Last Name
*22. Mother's Occupation
*23. Mother’s phone
*24. Father's First Name
*25. Father's Last Name
*26. Father's Occupation
*27. Father’s phone
*28. Parents' Marital Status
Parent’s address
*29. Street address
*30. City
*31. State
*32. Zip
*33. Was your father born Jewish?
*34. Was your Mother born Jewish?
Educational Information
*35. High School attended
*36. Year of graduation
*37. Undergraduate University/College attended
*38. Year of graduation/Projected graduation
*39. Undergraduate major
40. Graduate school attended
41. Year of graduation/Projected graduation
*42. List any groups, clubs, or fraternities/sororities you belong to. (Please indicate if you hold a position in any of these organizations and, what your position is):
*43. Describe your academic interests, hobbies, and extra-curricular activities
Employment background
*44. Current employment status
*45. Name of employer
*46. Position
*47. City or Borough where you work
Jewish Background
*48. Have you participated in Jewish educational programs before?
Yes
No
49. If yes, please list which program(s) (include location, month, & year)
*50. Have you participated in a Birthright trip to Israel
Yes
No
51. If yes with which Birthright provider
52. Year you went on Birthright trip
*53. Do you know how to read Hebrew?
Yes
No
*54. Have you ever attended a Jewish School?
Yes
No
55. If yes, what was the name of the school?
56. How many years did you attend?
57. Which grades?
*58. What is your current Jewish affiliation?
*59. Do you hold any leadership/professional positions in Jewish organizations?
Yes
No
60. If yes, please describe
*61. Have you ever participated in any Jewish educational trips (not including RAJE trips or Birthright)
Yes
No
62. If yes, please describe (include name of organization, year of trip, and destination)
Involvement in RAJE
*63. Have you participated in RAJE Fellowship programs or trips?
Yes
No
64. If yes, please list programs in which you participated, include program name, year and semester
65. Please list any friends who have participated in RAJE programs
66. Please list any friends who are applying with you to the program
*67. Briefly explain what you hope to gain from the RAJE Fellowship program
*68. How did you hear about the program
*69. Do you use Twitter?
Yes
No
70. If yes, what is your Twitter name?
71. How often do you Tweet?
*72. Do you have a Blog?
Yes
No
73. If yes, what is your Blog address?
74. What service provider do you use?
75. How often do you Blog?
*76. Have you ever made a YouTube video?
Yes
No
77. If yes, how many YouTube videos have you posted?
78. Do you video Blog?
Yes
No
*79. Do you use Facebook?
Yes
No
80. If yes, how often do you update your Facebook status:
81. How often do you check the Facebook status of your friends:
*82. Do you use social networking sites other than Facebook?
Yes
No
83. If yes, which ones