Exhibit J Seminar Application

We're so happy you're applying to the Exhibit J Seminar!

We're looking forward to getting to know you. Please fill out this form in its entirety. Contact us if you have questions - Rina 718.730.4270
Application Form - General Information

Who are you? :)
First Name
Last Name
Gender
Date of Birth

MonthDayYear
Mobile Number

Area CodePhone Number
E-mail
Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family & Religious Background
My Grandparents are:
If ANY (of all 4) of your grandparents were not born Jewish, please elaborate on which and if they underwent conversion.
Mother's First & Maiden Name
My mother is:
Father's First & Last Name
My father is:
Are these your birth parents
Occupation

What are you up to?
Are you currently in school?
Select an option
Name of College / University
If you're not studying now, which school did you attend in the past?
Year
Are you currently working?
Select an option
If yes, in what capacity?

Jewish Education History
Have you ever been to Israel? If so what programs?
Have you ever had exposure to Jewish learning or had formal Jewish education?
If yes, please elaborate.
What other types of Jewish experiences have you had? (Bar/Bat Mitzvah, Youth Group, Fraternity/Sorority, etc.)
If yes, please, which.
How would you describe your Jewish observance?
Have you ever been on an organized trip to Israel or Poland, besides Birthright? If so, please specify.
What do you expect from this program?
This is the really important part – we want to make this program awesome, and for that we need the input of the participants.
Other Stuff We Need to Know

For liability reasons and in case we go on a trip.
Do you have any special health needs?
If yes, please, which.
Are you currently taking any medication?
If yes, please, which.

Recommendations

Share the wealth!
Know of any friends or classmates that would benefit from this program?
Write down their name(s) and contact info, and we'll tell them about the Exhibit J Seminar. Recommending high quality students increases your own chances of being accepted to the program.
Do you have any college-age siblings or cousins who haven't participated in Exhibit J programs yet?
Write down their name(s) and contact info, and we'll tell them about the Exhibit J Seminar. Recommending high quality students increases your own chances of being accepted to the program.
How did you hear about us?
Friend? Classmate? Advertisement? Met the rabbi on campus and he reeled you in? :) Let us know, please.
Some Technical Stuff
Registration Fee: If I am accepted into the Exhibit J Seminar, I understand that participation requires a $100 refundable fee. After 8 sessions and 1 Shabbat are completed, the $100 will either be refunded or applied toward my Poland/Prague Trip fee
I understand that participation in the seminar does not automatically ensure my acceptance for the Poland/Prague trip. I will apply for the trip later in the year.
PHOTO RELEASE

I hereby grant permission, without reservation, to Exhibit J and those authorized by Exhibit J to take photographs and to make recordings of me, and to use them in original or modified form in all media now or hereafter known, with or without my name or information about me, for the promotion, public education, and/or fundraising activities of Exhibit J.

I understand and agree that I am entitled to receive no compensation for the above. I hold harmless and release and forever discharge Exhibit J, its officers, directors, agents, employees, independent contractors, licensees, and assignees from all claims, demands, and causes of action that I, my heirs, representatives, executors, administrators, or other persons acting on my behalf or on behalf of my estate now have or in the future may have, relating to the above.

I agree that Exhibit J will be the sole owner of all tangible and intangible rights in the above-mentioned photographs and recordings, with the full power of disposition.
I agree to the above.
Olami Requirements

Olami is an international organization that supports programs like Exhibit J around the world. They will be partially subsidizing both this seminar and the culminating trip to Poland & Prague. Here are 3 items they require all of our students to read and complete:
Olami Consent Form

With programs in over 30 countries, Olami and its funding partners sometimes use independent verification firms to assure that programs are attended and impactful.
By registering, I understand that I might be contacted by a verification firm for quality control purposes.
Olami is funded in part by Mosaic United.
Indicate below if you don't want to be contacted regarding future Mosaic sponsored-opportunities.

Other
Olami Jewish Youth Pledge

Think about the impact your Jewish experiences have had on you. The things you do today can impact your future actions and help you to remain a link in the Jewish chain of generations. What advice do YOU want to give yourself for the future?

Every two years, you will get a text reminder about your letter. On the 5th, 10th, and 20th anniversaries of signing, you will receive the full text of your letter so you can remember this moment.Make it meaningful and tell yourself what’s truly important to YOU!
"Dear future self…"
Agreement

All personal information will be held in strict confidence.
I affirm that all the information provided in this application is true, and if found to be falsified may be a basis for disqualification in this and all future programs.
Math Challenge
Should be Empty:

We're so happy you're applying to the Exhibit J Seminar!

Application Form - General Information

Family & Religious Background

Occupation

Jewish Education History

Other Stuff We Need to Know

Recommendations

Some Technical Stuff

Olami Requirements

Agreement