| Introductory information |
| * First Name: |
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| * Last Name: |
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| * Gender: |
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| * Date of Birth: |
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| * What University are
you currently attending?: |
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| * Name of Maimonides
campus you wish to attend: |
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| * Your Address at
School: |
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| * Email address: |
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| * How would you describe your Jewish affiliation? |
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| * Is your mother Jewish?
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* if yes,
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| * Is your father Jewish? |
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* if yes,
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| Are these your birth parents? |
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If no, please explain:
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Please list the names and ages of your siblings:
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| Do you have any special medical needs? |
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Explain:
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If you are taking, or have taken in
the past (on a protracted basis) any medication for any aspect of your health,
please indicate:
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| Education: |
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| * What was is the highest level of Jewish education you've completed? |
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Describe your Jewish educational background (if any):
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| If so, what year?
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| * How would you describe your level of Hebrew proficiency? |
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List chronologically all the schools you
have attended:
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* In two paragraphs,
please explain what you hope to gain from the Maimonides Leaders Fellowship
program.
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| All personal information will be held in
strict confidence.
I affirm that all the information provided in this application is
true, and understand the Maimonides Leaders Fellowship guidelines enumerated
below:
1) I understand that in order to receive the full fellowship I
will need to attend all the program components including weekday seminars,
weekend events, and graduation. I also understand that failure to attend the
above-stated events will result in a prorated deduction from program stipend.
2) I will comply with all basic standards of program conduct in a
manner befitting a Maimonides Fellow. MLF reserves the right to ask any fellow
to discontinue participation for any reason it sees fit. In such event the
student will not receive any Fellowship funds.
3) A personal interview may be required before final admission.
MLF admits
students of any race, color, national and ethnic origin.
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Be sure you have selected the correct
school in order for the appropriate representative to receive your application
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