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Netivot Aliya 2024-2025 Application Form
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Option 1
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Applicant full Name
*
Your answer
Both parents' names
Your answer
Both parents' emails
Your answer
Both parents' cell phone (whatsapp) #
Your answer
Birthday
Your answer
Email
*
Your answer
Address
*
Your answer
Israeli cell phone number (if you have)
*
Your answer
WhatsApp #, if different than Israeli #
Your answer
High school (current and former if applicable)
Your answer
Current institution of learning (if post high school)
Your answer
Year made Aliya or date planning to make Aliya
Your answer
City/Country made Aliya from
Your answer
Did you make aliya ?
alone
with your family
didn't make aliya yet
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How did you hear about Netivot Aliya?
Your answer
I am applying for:
Aliza's Track (Sherut Leumi+ - full-time Sherut, live together with other English speakers and enjoy extra-curricular learning and social activities)
Yarden's Track (Extra Support - reduced work hours, weekly Yom Hakshara, life-skills classes & workshops, mentors for each apartment)
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About you:
How are your Hebrew language skills?
strong: fluent in speaking and understanding
medium: can get by with basic Hebrew understanding and speaking
weak: need support to speak and understand
Other:
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Have you ever had a job? Please elaborate
Your answer
Will you have graduated High school after this year?
Yes with Bagruyot completed
Yes without Bagruyot
yes with a GED or diploma from outside of Israel
No
Other:
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Special Requirements
Do you have any physical limitations or restrictions?
Yes- please explain:
No
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Are you currently taking medication? If so, please elaborate.
Your answer
Do you have any allergies or special dietary requirements? If so, please elaborate.
Your answer
Are you currently receiving medical treatment or psychological counseling? If so, please elaborate.
Your answer
Why do you want to be in this program?
The extras: what interests you? Check all that apply:
ulpan to improve Hebrew
Inspirational religious learning: discussion based and speakers
tools for life workshops: relationships, identity, self esteem, Isreali society, etc.
creative workshops: art/music/ cooking
Shabbatonim and tiyulim
Regular meetings one on one to help you with adjustments etc.
Other:
Is there anything else you would like to see in this program:
Your answer
Netivot Aliya a non profit program and all money goes directly to program expenses. Tax receipts can be given (US or Israel) . Netivot Aliya is partially funded through Aminadav but we rely on donations to fund our extra services. It would help us cover our expenses if families could donate $1,000US or 3,000NIS.
I would like to donate $1,000/3,000NIS
I would like to donate another amount
I cannot donate
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Reference:
someone who knows you: teacher, principal, rabbi, etc.
name:
Your answer
contact info:
Your answer
relationship to you:
Your answer
Thank you for completing the application! Please also send a WhatsApp to (or call):
Sherut Leumi+: Aliza Assayag +972 54-523-4563
Extra Support: Yarden Greenberg: +972 52-396-6496
to schedule an interview
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