About Your Organization
Tell us about you and your organization
Your name
*
First Name
Last Name
Your position
*
Your full organizational name
*
Your email address
*
example@example.com
Your mobile phone number
*
-
Country Code
-
Area Code
Phone Number
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Bank and Non-Profit Registration Details
Legal Organizational Name or Fiscal Sponsor (as listed on bank account)
Please submit the name of your bank, bank address, and full bank details including account number, ABA, IBAN or SWIFT number (as applicable to your organization).
EIN or Non-Profit Registration Number
Where is your organization incorporated?
*
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Upload your certificate of non-profit incorporation
*
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Your Organization and Experience
Tell us about your organization. This may include information about its general ongoing activities, general target population, goals, and more.
*
0/300
Share your online presence
*
Which related activities do you operate today?
*
Describe your organization's camp related experience. Share about your typical camp target audience, if different from your organization target audience as described above.
*
0/500
Upload any evaluation reports, flyers, or other materials which demonstrate your experience here.
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Your Application
Please select which track you would like to submit an application for:
*
Day camp
Overnight camp
Family camp
Weekend retreat / Shabbaton
Would you also like to submit an application for pre-camp seminars for counselors? If yes, please select the option below.
Yes, I would like to submit an application for pre-camp seminars for counselors
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Day Camp Proposal
Your offering will:
*
Please Select
B an extension of an existing program
Serve Ukrainian Jews only
Will you be offering more than one day camp session?
*
Yes
No
Camp Start Date
*
-
Day
-
Month
Year
Please note, the typical day camp duration is between 5-21 days.
Camp End Date
*
-
Day
-
Month
Year
Please list the dates for all day camp sessions you are offering. Please note, the typical day camp duration is between 5-21 days.
Please enter your dates as DD/MM/YYYY
Estimated number of total camp participants:
*
Estimated number of Ukrainian Jewish camp participants:
*
Note that a participant can only participate in a single track
If you received funding last year from Mosaic United, please provide an estimated number of new Ukrainian Jewish participants.
The number of Ukrainian Jewish participants who were *not* previously sponsored by Mosaic United
Age range of participants:
*
Estimated number of days of operation:
*
If you are running multiple camp sessions, enter the total number of days. For example, if you have three 5-day camp sessions, you would enter 15.
Languages offered include, but are not limited to:
*
Ukrainian
Russian
We don't have one or more of these language resources, but we'd like to add them if Mosaic can help
Describe in detail the camp's location, including the country, town, or area where it is located, as well as any notable characteristics of the surrounding environment and nearby attractions or points of interest. Additionally, please describe the camp site's facilities and amenities in detail.
*
0/300
Describe the camp's activities including its Jewish programming and Israel programming content and frequency. Include details about the educational team, number of counselors, and the counselors' experience.
*
0/1000
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Overnight Camp Proposal
Your offering will:
*
Please Select
Be an extension of an existing program
Serve Ukrainian Jews only
Will you be offering more than one overnight camp session?
*
Yes
No
Camp Start Date
*
-
Day
-
Month
Year
Please note, the typical overnight camp duration is between 7- 14 nights.
Camp End Date
*
-
Day
-
Month
Year
Please list the dates for all overnight camp sessions you are offering. Please note, the typical overnight camp duration is between 5-21 days.
Please enter your dates as DD/MM/YYYY
Estimated number of total camp participants:
*
Estimated number of Ukrainian Jewish camp participants:
*
Note that a participant can only participate in a single track
If you received funding last year from Mosaic United, please provide an estimated number of new Ukrainian Jewish participants:
The number of Ukrainian Jewish participants who were *not* previously sponsored by Mosaic United
Age range of participants:
*
Estimated number of nights of operation:
*
If you are running multiple camp sessions, enter the total number of night. For example, if you have three 7-night camp sessions, you would enter 21.
Languages offered include, but are not limited to:
*
Ukrainian
Russian
We don't have one or more of these language resources, but we'd like to add them if Mosaic can help
Describe in detail the camp's location, including the country, town, or area where it is located, as well as any notable characteristics of the surrounding environment and nearby attractions or points of interest. Additionally, please describe the camp site's facilities and amenities in detail.
*
0/300
Describe the camp's activities including its Jewish programming and Israel programming content and frequency. Include details about the camp's educational team, number of counselors, and the counselors' experience.
*
0/1000
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Family Camp Proposal
Your offering will:
*
Please Select
Be an extension of an existing program
Serve Ukrainian Jews only
Will you be offering more than one family camp session?
*
Yes
No
Camp Start Date
*
-
Day
-
Month
Year
Please note, the typical family camp duration is between 7-14 nights.
Camp End Date
*
-
Day
-
Month
Year
Please list the dates for all family camp sessions you are offering. Please note, the typical family camp duration is between 7-14 nights.
Please enter your dates as DD/MM/YYYY
Estimated number of total camp participants:
*
Estimated number of Ukrainian Jewish camp participants:
*
Note that a participant can only participate in a single track
If you received funding last year from Mosaic United, please provide an estimated number of new Ukrainian Jewish participants:
The number of Ukrainian Jewish participants who were *not* previously sponsored by Mosaic United
Age range of participants:
*
Estimated number of nights of operation:
*
If you are running multiple camp sessions, enter the total number of nights. For example, if you have three 7-night camp sessions, you would enter 21.
Languages offered include, but not are not limited to:
*
Ukrainian
Russian
We don't have one or more of these language resources, but we'd like to add them if Mosaic can help
Describe in detail the camp's location, including the country, town, or area where it is located, as well as any notable characteristics of the surrounding environment and nearby attractions or points of interest. Additionally, please describe the camp site's facilities and amenities in detail.
*
0/300
Describe the camp's activities including its Jewish programming and Israel programming content and frequency. Include details about the camp's educational team, number of counselors, and the counselors' experience.
*
0/1000
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Weekend Retreat or Shabbaton Proposal
Your offering will:
*
Please Select
Be an extension of an existing program
Serve Ukrainian Jews only
Will you be offering more than one Weekend Retreat or Shabbaton?
*
Yes
No
Retreat/Shabbaton Start Date
*
-
Day
-
Month
Year
Please note, the typical weekend retreat/Shabbaton duration is between 1-3 nights.
Retreat/Shabbaton End Date
*
-
Day
-
Month
Year
Please list the dates for all weekend retreat or Shabbatons that you are offering. Please note, the typical weekend retreat/Shabbaton duration is between 1-3 nights.
Please enter your dates as DD/MM/YYYY
Estimated number of total participants:
*
Estimated number of Ukrainian Jewish participants:
*
Note that a participant can only participate in a single track
If you received funding last year from Mosaic United, please provide an estimated number of new Ukrainian Jewish participants
The number of Ukrainian Jewish participants who were *not* previously sponsored by Mosaic United
Age range of participants:
*
Estimated number of nights of operation:
*
If you are running multiple retreats/shabbtons, enter the total number of nights. For example, if you have three 2-night retreats/shabbatons, you would enter 6.
Languages offered include, but are not limited to:
*
Ukrainian
Russian
We don't have one or more of these language resources, but we'd like to add them if Mosaic can help
Describe in detail the camp's location, including the country, town, or area where it is located, as well as any notable characteristics of the surrounding environment and nearby attractions or points of interest. Additionally, please describe the camp site's facilities and amenities in detail.
*
0/300
Describe the camp's activities including its Jewish programming and Israel programming content and frequency. Include details about the camp's educational team, number of counselors, and the counselors' experience.
*
0/1000
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Pre-Camp Seminar for Counselors
Your offering will
*
Please Select
be an extension of an existing program
serve Ukrainian Jews only
Will you be offering more than one Pre-Camp Seminar for Counselors?
*
Yes
No
Pre-Camp Seminar Start Date
*
-
Day
-
Month
Year
Please note, the typical pre-camp seminar duration is between 2-4 nights.
Pre-Camp Seminar End Date
*
-
Day
-
Month
Year
Please list the dates for all pre-camp Seminars that you are offering. Please note, the typical pre-camp seminar duration is between 1-3 nights.
Please enter your dates as DD/MM/YYYY
Estimated number of total seminar participants:
*
Estimated number of Ukrainian Jewish seminar participants:
*
Note that a participant can only participate in a single track
Age range of participants:
*
Estimated number of nights of operation:
*
If you are running multiple seminars, enter the total number of nights. For example, if you have three 3-night sessions, you would enter 9.
Languages offered include, but not limited to:
*
Ukrainian
Russian
We don't have one or more of these language resources, but we'd like to add them if Mosaic can help
Describe in detail the seminar's location, including the country, town, or area where it is located, as well as any notable characteristics of the surrounding environment and nearby attractions or points of interest. Additionally, please describe the seminar site's facilities and amenities in detail.
*
0/300
Describe the seminar's activities including its Jewish programming and Israel programming content and frequency. Include details about the seminar's educational team, number of counselors, and the counselors' experience.
*
0/1000
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Approximate Funding Eligibility Calculator
Please select the tracks for which you are applying. For each selected track enter the number days of operations calculated for that track earlier in the application.
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( X )
Day Camp
In quantity, please enter the estimated number of days of operation calculated previously.
$
45.00
Number of Days
Overnight Camp
In quantity, please enter the estimated number of nights of operation calculated previously.
$
80.00
Number of Nights
Family Camp
In quantity, please enter the estimated number of nights of operation calculated previously.
$
85.00
Number of Nights
Weekend Retreat or Shabbaton
In quantity, please enter the estimated number of nights of operation calculated previously.
$
95.00
Number of Nights
Pre-Camp Seminars for Counselors
In quantity, please enter the estimated number of nights of operation calculated previously.
$
85.00
Number of Nights
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Agreements
You and your organization have read and agreed to the terms of the RFP as provided here: https://drive.google.com/file/d/1LpcgFneLtCiu_mETRlXzNq7DWANiUBnZ/view
*
Yes, we agree.
You acknowledge that Mosaic United will provide funding and resources. You confirm that recruitment of Ukrainian Jewish participants, staffing, and all other aspects of providing the offerings you propose in this application are the responsibility of your organization.
*
Yes, we confirm.
Your organization has the staff capacity and capability to provide Jewish programming, content, and/or education. If your offering will coincide with Shabbat and/or a Jewish holiday, you will mark it in a meaningful way.
*
Yes, we are qualified, and will mark Shabbat and Jewish holidays if they coincide.
Your organization has the staff capacity and capability to provide Israel programming, content, and/or education.
*
Yes, we are qualified.
Your organization shall at all times be in compliance with all applicable laws, health and safety regulations, and other standards required by law. Your organization carries sufficient liability insurance.
*
Yes, we are in compliance and insured.
Your organization is in compliance with Israel's Law for the Prevention of the Employment of Sex Offenders in Certain Institutions, 5771-2001, and/or the appropriate equivalent in the country of origin.
*
We are in compliance with Israel's Law for the Prevention of the Employment of Sex Offenders in Certain Institutions
Other
Your organization either does not receive funding from either Mosaic United or the Government of Israel – or your organization must disclose it
*
We do not receive funding from the Government of Israel or Mosaic United
Other
Your organization will provide individual participant data to Mosaic United.
*
Yes
Your organization will cooperate fully with all audits and evaluations as requested by Mosaic United or its partners
*
We will cooperate with audits and evaluations.
You are authorized to submit this application and sign on behalf of your organization.
*
I am authorized.
You confirm that no other consolidated application has been submitted on behalf of the camps listed in the application currently being submitted.
*
I confirm
You agree that your application is accurate to the best of your knowledge.
*
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