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Netivot Aliya 2021-2022 Application Form
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Applicant full Name
*
Your answer
Parents names , email and cell #:
Your answer
Birthday
Your answer
Email
*
Your answer
Address
*
Your answer
Cell phone number
*
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
Clear selection
How did you hear about Netivot Aliya?
Your answer
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:
Clear selection
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:
Clear selection
Special Requirements
Do you have any physical limitations or restrictions?
Yes- please explain:
No
Clear selection
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 is partially funded through Aminadav but we rely on donations to fund our extra services. Tution for the year is 1000$US or 4000NIS. Scholarships are available for any girl that is not able to pay. This is a non profit program and all money goes directly to program expenses. Tax receipts can be given (US or Israel) .
I do not need a scholorship
I need a scholorship
Other:
Clear selection
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! We will be in touch with you soon! We will also be doing personal interviews in person or by phone.
Your answer
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