Please fill out the online form
below and click Submit
Fields marked with a red asterisk (*)
are mandatory: |
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* Dates of the session
you would like to attend
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* First Name
| Middle Initial
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* Last Name
| Hebrew Name
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* Gender:
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* Address
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* City
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* State
| * Zip Code
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Permanent Address (if different)
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* Phone (day)
| Phone (night)
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* Phone (mobile)
| Phone at permanent address (if different)
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* E-mail
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* Marital status
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* Date of Birth (mm/dd/yyyy)
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* Were you ever in Israel?
| Dates of visit
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Reason for visit
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*Did you attend Birthright?
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* Was your mother born Jewish?
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* Was your father born Jewish?
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If no, please explain
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* Father's name
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* Father's Email address
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Father's phone (day)
| Father's phone (night)
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Father's Address
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City, State
| Zip Code
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Email Address for Father
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* Mother's name
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* Mother's Email address
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Mother's phone (day)
| Mother's phone (night)
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Mother's Address
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City, State
| Zip Code
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Email Address for Mother
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* Parents' marital status
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* Emergency Contact Name
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* Emergency Contact Number
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Education
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* Present Occupation
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Name of Employer (if applicable)
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Brief Job Description:
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List chronologically all the schools you have attended:
Secondary Schools |
* Name of School
| * Location
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* Dates of Attendance
| * Graduation Date and Degree Awarded
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| College or University |
* Name of School
| * Location
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* Dates of Attendance
| * Graduation Date and Degree Awarded
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| Jewish Schools (if not included in above) |
Name of School
| Location
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Dates of Attendance
| Graduation Date and Degree Awarded
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* What Jewish Education have you had?
If Other, Explain (Jewish Education):
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If you attended afternoon Hebrew School, how many years did you attend?
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If you attended Day School, how many years did you attend?
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* How would you describe your Jewish education?
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Hebrew language proficiency
* Read:
Not at all
Minimal
Average
Very well or fluent
* Speak:
Not at all
Minimal
Average
Very well or fluent
* Understand:
Not at all
Minimal
Average
Very well or fluent
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| Have you ever studied (please check all
that apply): |
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If you checked any of the above subjects above, what did the course consist of,
and where did you take the course?
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Languages spoken at home
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Activities and Outreach Organizations in which you have participated
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* Do you hold any leadership/professional positions in Jewish organizations?
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Position:
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* How would characterize your Jewish observance:
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* Comp to others, Jewish causes are:
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* Desire to be close to Jewish people:
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* What is your attitude towards marriage:
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* Will your children's education have:
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* Are there any special characteristics of
your medical history that would affect your ability to participate
in the Program? If so please describe
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* If you are taking, or took in the past (on a protracted basis)
any medication for any aspect of your health, please
indicate:
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* Do you have any accessibility requirements or physical limitations or restrictions?
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| List two persons who can serve as references for you: |
* Name 1
| * Phone 1
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Address 1
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* Relationship to you 1
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* Name 2
| * Phone 2
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Address 2
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* Relationship to you 2
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* How did you hear about the Heritage Retreats?
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Tuition Information
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Tuition for the Heritage Retreats Programs is as follows:
Men's Program at Glacier National Park
Students:
$199 for individuals whose applications are received before
June 1st
$250 for individuals whose applications are received after
June 1st
Non Students:
$299.00 for individuals whose applications are received
before June 1st
$335.00 for individuals whose applications are received
after June 1st
Women's Program in Muskoka, Ontario
Students:
$199 for individuals whose applications are received before
July 1st
$250 for individuals whose applications are received after
July 1st
Non Students:
$299.00 for individuals whose applications are received
before July 1st
$335.00 for individuals whose applications are received
after July 1st
There is an additional $50.00 transportation fee for individuals who will need Heritage Retreats to provide them with transportation to and from the retreat location.
Tuition is due upon receipt of written (either hard copy or email) acceptance to the program. We must be in receipt of your Tuition money in order to guarantee your spot in the program.
Participants who received a scholarship, please refer to the information package you received.
Financial Aid:
Scholarships are available for eligible applicants. Please be in touch with
Heritage Retreats at 800-927-0476 (or 866-268-7169 from Canada), or email us to discuss
scholarship options.
Refunds:
Cancellations received more that 1 month prior to the session will be refunded in full, less a $100.00 cancellation fee.
Cancellations received less than one month before the session are non- refundable.
Miscellaneous Information:
A personal interview may be required before final admission.
All personal information will be held in strictest confidence.
Heritage Retreats admits students of any race, color, national and ethnic origin.
Any student not complying with program requirements during his or her stay at Heritage Retreats may be asked to leave. In such event, all fees would be refunded on a prorated basis. |
* Please use the space below to write two paragraphs describing
what you hope to offer and gain from the Heritage Retreats program:
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By submitting this application online, I hereby affirm that all of the information included in this application is correct to the best of my knowledge, and that I have read and agree to the terms and conditions of tuition payment.
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