Application for Jewish College Cultural Tour of China
June 10 - 25 (Aprox)
Student Info
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
Male
Female
Non-Binary
Prefere not to say
Eligibility: Identity and Location
Cultural background
Jewish
Jewish parent or grandparent
No Jewish background but very interested in Jewish history and culture
Other
What city are you primary association(either perminant address or school attending)
Des Moines, IA
Ames, IA
Iowa City, IA
Omaha, NE
Austin, TX
Canton, OH
Dayto, OH
Fort Wayne, IN
Fort Worth.TX
Indianapolis, IN
Lansing, MI
Peoria, IL
San Antonio, TX
South Bend, IN
Springfield, IL
Toledo, OH
Youngstown, OH
Northeastern New York
Other
Name of College or University (if graduted list that)
College City and State
College Status
Currently in 2 or 4 year College
Not currently in College but graduted after 4/24
Currently in Graduate School (first 2 yearsand under 25)
What City and State is Home
Travel Related
Passport and Visa
Valid passport USA that will expire after 1/1/26
Valid Passport USA that will expire before 1/1/26
Valid passport Israel That will expire after 1/1/26
Valid passport Israel that expires before 1/1/26
Valid passport other country
Valid visa to China from previous trip
Country of passport if not USA or Israel
Passport Number
Passport expiration date
Emergency Contact
Name
Relations
Phone
E-mail
Medical Dietary
Dietary(pick all that apply)
Kosher
Vegan
Vegitarian
Glutan Free
Other
Are there any medical or physical conditions you want to let us know about.
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Deposit
$300.00
$
300.00
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Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
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2040
2041
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2045
Expiration Year
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"I understand the $300 deposit is an administrative fee. If selected, it is non-refundable. If not selected, it will be refunded minus a 10% transaction fee."
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