HiBuR 2023-24 Application Form

HiBuR 2023-24 Application Form
Dear applicant,

Below you will find the full HiBuR 2023-24 Application Form. The form has 4 sections:
1. Applicant informaiton
2. Applicant's parents/ugardians informaiton - can be filled for one or two parents/guardians.
3. Hosting the travel information - while this part might seem a little intrusive, the information asked for is needed in order for us to create sucsesful pairings with the Israeli students.
4. Deposit - submitting the form along with a deposit of $500 is the only way to guarantee* your place in next year's cohort. The deposit can be paid online or with a check, will count towards the program's tuition, and is non-refundable**.
If in the course of filling out the application anything is unlear, please reach out to Shoni - hibur@jloftboston.org / 702-684-1161

* While extremely rare, HiBuR keeps the right to refuse participation, if it believes the program is not a good fit for an applicant.

** Deposit will be refunded in two scenarios: if the program doesn't end up taking place (due to Covid or other reasons), or if HiBuR rejects and application.
Applicant information
Applicant's Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Grade in the '22-23 school year (next year)*

9th10th11th12th
Pronouns
Temple or Group Affiliation (if applicable)
School*
Applicant's dietary Restrictions and Allergies
A detailed medical form will be filled later on, but for now knowing about any dietary restrictions such as being Vegetarian, or allergies that can impact the hosting situation such as "allergic to cats" are helpful.
Parents/Guardians information
Parent/Guardian 1 Name*

First NameLast Name
Parent/Guardian 1 Email*
example@example.com
Parent/Guardian 1 Phone Number*
Please enter a valid phone number.
Parent/Guardian 1 Address (if different from student's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Email
example@example.com
Parent/Guardian 2 Phone Number
Please enter a valid phone number.
Parent/Guardian 2 Address (if different from student's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hosting and Travel Information
How many Israeli students are you willing and able to host*
Preferred gender of the host students*
Please shortly describe the space in which you plan on hosting the Israeli student/s*
Examples: Student will stay in vacant room of older sibling who's in college / Student will have a separate bed in the participant's room.
Pets in the house*
Examples: none, two dogs, one snake
Kosher kitchen*
Examples: no kosher at all, fully kosher, no pork and shellfish
Does the applicant have a valid passport*

YesNo
Country of Passport
Passport Expiration Date

MonthDayYear
Date
Deposit
In order to gurantee the student's place in the program, a deposit of $500 must be submitted. For your convinience, you can choose to pay via check or online with a debit/credit card. The deposit will count towards the the program's full tuition, which we expect to be around $3,500.

In case the program ends up not taking place, due to covid or any other reason, the deposit will the be fully refunded.
Please select your preferred payment method*

Debit/Credit CardCheck
Please mail check to:

Congregation Beth El

105 Hudson Rd, Sudbury MA 01766

Attn: Hibur
Pay Online
prevnext( X )
HiBuR Deposit
$500.00

Total

$0.00
Comments, questions, or requests for any special accommodations:
Should be Empty:

HiBuR 2023-24 Application Form

Applicant information

Parents/Guardians information

Hosting and Travel Information

Deposit