TJJ for Moms Application – Summer 2023 TJJ For Moms Application Summer 2023 1Personal/Contact Info2Family3Affiliation4Emergency Info5Terms Agreement Personal InformationName* First Last Full legal name as it appears on your passport*Passport NumberHebrew NameContact InformationEmail Address* Home Phone #*Cell Phone #*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Price for first timers with NCSY $499.00 plus $500 deposit (total $999) does not include airfare. Price for second timers with NCSY $799.00 plus $500 deposit (total $1350) does not include airfare. Deposits are due 3 days after acceptance, and remaining fee March 1, 2023. Requirements for the trip A commitment to attend three programs prior to the trip and ten programs after. In addition we require one of your children to attend 3 programs run by NCSY.* Completion of application does not guarantee acceptance into our program. * to be discussed with staff on an individual basis. Family InformationDo you have children?* Yes No Please list their names, ages and school they attend:*NameAgeSchool (click the plus sign to add more children)Have your children had any of the following Jewish education?* Jewish Preschool Jewish Elementary School Jewish High School Hebrew School Jewish Camp Are any of your children involved in NCSY/JSU programming?* Yes No Which programs?*Are they involved in any other youth organization?*Which areas of Jewish programming would interest your teen?*Have you previously been on a Moms trip to Israel?* Yes No How did you hear about TJJ for moms?* Jewish AffiliationPlease check off which one is appropriate to depict your Jewish Heritage* Born to Jewish parents Born to Jewish mother Born to Jewish father Converted Not Jewish Are you a member of a synagogue?* Yes No Which synagogue?*How often do you attend?*Have you ever been to Israel?* Yes No When have you been to Israel?*Have you had any Jewish education?* Jewish Preschool Jewish Elementary School Jewish High School Hebrew School Jewish Camp Have you ever held a position on a board, in your community or religious institution? if yes, which one?* Additional InformationEmergency Contacts*NamePhone #EmailRelation (click the plus sign to add more contacts)Allergies*What is your t-shirt size?*SMLXLXXLXXLTrip Date Options:* July 12-20 July 30-Aug 7 I'm flexible Anything else we should know? Click here to view the terms and conditionsTerms and Conditions* I agree to the terms and conditions.
Tri-State
Tri-State