Yiddish Farm Application

Please apply for Yiddish Farm courses here. If you have questions please email info@yiddishfarm.org

Current Offerings, Dates, and Fees

Semester @ Yiddish Farm

Women's: January 15th through March 10th, 2021

Men's: April 15th to June 10th, 2021

$3500/person, discounts available.

Yiddish Sundays:

Session 1: July 4th, 11th, 18th, 25th

Session 2: August 1st, 8th, 15th, 22nd

$500/person

Name

First NameLast Name

Jewish Name if Different

First NameLast Name

I am interested in registering for:

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Age

Enter Age

Gender

Which living arrangement best describes your own needs? Private accommodations will not be available for this year's winter program

Other

How do you intend to pay?

Please list any allergies

Are you a smoker?

What are your goals for the program?

Do you know any Yiddish?

Do you know the Hebrew alphabet?

Some skills that I can contribute to the program are:

Are you Jewish? If yes, please describe your Jewish background. If not, please describe your religious background:

Do you have a criminal record?

Do you have physical, mental or emotional needs that will require adaptation in housing, program activities, communal living, and/or communication?

If you answered yes to the above, please explain:

Do you have a history of drug or alcohol abuse?

Please list any medications you are currently taking:

Please list any significant past illnesses, medical or mental health problems:

How did you hear about this program?

Emergency Contact Name

First NameLast Name

Emergency Contact Number

Area CodePhone Number

Emergency Contact Relation

Is there anything else you'd like us to know?

Please Provide 2 Character References

Please include phone number and relation. (Remember to tell your references that you are listing them here) No family please.

Comments and Questions