JLIC Winter Break Volunteer Trip

General Information
Name*
First Last
Email*
Cell Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gender*
University*
Yeshiva/Midrasha you attended in Israel if applicable*
Are you a Yavneh Fellow?*
- Yes
- No
Have you done a JLIC Summer or Volunteer Program? If yes, which one?*
Have you done any other Birthright Volunteer Trip?*
- Yes
- No
Dietary Restrictions*
I understand that this Volunteer trip is an 8 day trip and I must be present for all 8 days*
- I Understand
Emergency Contact Information
Parent/Legal Guardian #1:*
First Last
Email*
Cell Phone*
Relationship to applicant*
Parent/Legal Guardian #2*
First Last
Email*
Cell Phone*
Relationship to applicant*
Emergency Contact in Israel*
First Last
Email*
Cell Phone*
Relationship to applicant*

General Information