Thank you for your interest in Camp Gesher! Our 2019 trip is now full! If you’d like to be added to the waitlist, please fill out the application below! Name* First Last Email* Phone*Age*Birthdate* [symple_box color="red" fade_in="true" float="center" text_align="left" width=""] At this time, we are only accepting people from the NY/NJ area or the LA area.[/symple_box]Your City*Los AngelesNew YorkOtherGender*MaleFemaleJewish Nationality*AlegerianBuchariIraqiKafkaziMoroccanPersianSyrianTemaniTunesianAshkenaziHalf-Sephardi/Ashkenazi Passport #*Country of Citizenship*USACanadaAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country What extracurricular activities, hobbies and organizations are you involved in? Please describe your participation in them:* ParentsParent's Marital Status*MarriedSeperated/DivorcedWidowed (father deceased)Widowed (mother deceased)Was your father born Jewish?*YesNoPlease Explain Father's Situation* Was your mother *born* Jewish?*YesNoPlease Explain Mother's Situation* MotherMother's Name (First)*Mother's Name (Last)*Mother's Email*Mother's Phone*Mother's Occupation*FatherFather's Name (first)*Father's Name (last)*Father's Email*Father's Phone*Father's Occupation*Were ALL your grandparents born Jewish?*YesNoPlease Explain Grandparent Situation* Education / WorkAre you in school and/or working?* School Working School Name*School Graduation Year*Please Select201820192020202120222023+2018-2023Already graduated CollegeAlready graduated UniversityAlready Grad School GraduateOtherSchool Degree*School Focus/Major*Employer*Job Title* BackgroundJewish Affiliation*TraditionalOrthodoxConservativeReformJewish Education*Virtually NoneHebrew/Sunday SchoolJewish Day SchoolYeshiva/Seminary High School Describe your Jewish education*A turn offInsufficientCompleteDo you hold any leadership/professional positions in Jewish organizations? If so, please tell us about it- which organization? position? achievements...Have you ever been to Israel before?*YesNo[symple_box color="red" fade_in="false" float="center" text_align="left" width=""] Please be very truthful about this question, as we will follow up to verify this information. Thank you. People have not been truthful in the past and it caused them to pay a huge penalty. Your honesty is appreciated ;)[/symple_box]Check off all the trips/learning you've done in Israel (not including Family trips, Bar Mitzvahs, weddings or travelling with friends)* Birthright Aish JAM GoSephardic GoSephardic Level 2 Maor Israel 2.0 Hasbara Fellowships Post High School Yeshiva/Seminary Jewel Yeshiva/Seminary (2 months+) Yeshiva/Seminary for 1 Year+ *Cool, you went on Birthright (like most people!) How did you like it? Was it what you expected? Were you disappointed in any way?*My top 4 life priorities are:* Application Essay* REQUIRED - Fill this box with your story as to why you feel you want to go on our trip AND what you hope to gain from it.I'm Most Interested In The Following Position...* Counselor DJ Program Coordinator Photographer Videographer This year we're making it bigger than ever! We're looking for volunteers who want to bring their personal passions to the Gesher experience as well! Let us know which role(s) you're most interested in! ReferencesReference* Who Refered you to the program?* [symple_box color="blue" fade_in="false" float="center" text_align="left" width=""] Special Requirements[/symple_box]Do you have any accessibility requirements or physical limitations or restrictions?*YesNoplease elaborate accessibility resctrictionsDo you have special dietary requirements?*YesNoPlease elaborate dietary needsAre you or have you received medical treatment or psychological counseling?*YesNoplease elaborate treatmentsAre you currently taking any medication?*YesNoplease elaborate medicationHave you ever been hospitalized?*YesNoplease elaborate hospitalization Last part! (Please answer accurately)Are you a practicing Jew?*Not regularlyRosh Hashana/Yom KippourMajor HolidaysShabbatShabbat & KosherFully Observant How involved and excited are you to be part of your Jewish community?*I'm very turned off and uninvolvedI'm slight involved because there's nothing elseI'm involved because I have toI'm really involved because it's great