First Time Application

Your Info

Input name exactly as it appears on your passport

First Name*

Middle Name

Last Name*

Gender*

Male
Female

Date of Birth*

Trip Info

Which Trip are you Applying for?*

Israel
Poland
Stateside
Akiva 2 (Advanced Learning Program)

Akiva 1 Trip Dates*

Please select which Akiva 2 Trip you will be attending*

Jewel
Jewessence
Neve
I don't know / other

Please select which Akiva 2 Trip you will be attending*

If you are unsure about these options, select the "I don't know" option and someone will contact you.

Essentials
Ohr Somayach
I don't know / other

Select Jewel Trip Dates*

Select Essentials Trip Dates*

Poland Trip Dates*

Stateside Trip Dates*

December 9-25, 2024
Dates TBA

From Date

To Date

This field is hidden when viewing the form

Please specify your Campus

Trip Cost Varies by Campus

University of Texas
Washington University in St. Louis

Please specify your Campus*

UF - Gainesville
UCF - Orlando

Please specify your Campus*

ASU - Arizona State University
U of A - University of Arizona
University of Indiana
Other

Trip Cost for your Campus: $699 All Inclusive (subsidized by your campus)

Trip Cost for Other Campus: $999 All Inclusive

Country of Citizenship*

Full Name as you would like it to appear on a name tag:

Your Current Jewish Affiliation:*

Please specify Your Jewish affiliation:*

Have you ever been on any organized Israel Trips?*

Misrepresenting this information will disqualify you from the trip.

Yes
No

Please list the names of the trips that you have been on?*

It is very important that you list EVERY organized trip you have been on. Omitting any information will jeprodize your acceptance to Akiva.

How did you hear about Akiva?*

Referring individual or organization:*

School Information

Year of Graduation:*

Major:*

University / College:*

Please Specify Graduation Status:*

Please Specify University:*

Employment Information

(Mandatory if graduated)

Check if unemployed / in school

Unemployed

Current Employer:*

Job Title:*

Your Contact Information

Your Current Address:*

Street Address City State / Province / Region ZIP / Postal Code Country

Cell Phone:*

A phone number we can reach you personally on

Home Phone:*

This can be your parents home number

Your Email:*

Enter Email Confirm Email

Your Marital Status:*

Permanent / Parent's Address

Where do you call home?*

Living Situation:*

Check if same as address above

Same Address

Permanent Residence Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Family Background

Mother's First Name:*

Mother's Last Name:*

Mother's Occupation:*

Father's First Name:*

Father's Last Name:*

Father's Occupation:*

Was your birth father born Jewish?*

Yes
No

Was your birth mother born Jewish?*

Yes
No

Were all your grandparents born Jewish?*

Yes
No

Please summarize fathers conversion history if any:

Please summarize mothers conversion history if any:

Please summarize grandparents Jewish history:

Parents Marital Status:*

Parents Jewish Affiliation:*

Please specify Parents Jewish affiliation:*

Educational History

What extracurricular activities, hobbies and organizations are you involved in?*

What Jewish Education have you had?*

What college have you or are attending?*

How would you describe your Jewish education?*

How are your Hebrew skills?*

Do you hold any leadership/professional positions in Jewish organizations?*

Yes
No

Position:*

My top 4 life priorities are:

1*

2*

3*

4*

Character References

Please include name, address, phone, relationship to you and the best time of day he or she can be reached. Please do not include family or friends

Reference 1 - Name*

Relationship to Reference:*

Phone:*

Best time to call them:

Reference 2 - Name:*

Relationship to Reference:*

Phone:*

Best time to call them:

Special Requirements

Do you have any accessibility requirements or physical limitations or restrictions?*

Yes
No

Please elaborate:*

Do you have any special dietary requirements?*

Yes
No

Please elaborate:*

Are you currently receiving medical treatment or psychological counseling?*

Yes
No

Please elaborate:*

Are you currently taking any medication?*

Yes
No

Please list your medications:*

Click on the plus button on the right to add a line

Have you ever been hospitalized?*

Yes
No

Please explain:*

Survey

How do you identify yourself?*

How is Torah relevant to you?*

How often do you learn Torah?*

What is your attitude toward marrying someone Jewish?*

Will your children's education have:*

Upload a Photo of Yourself:

Drop files here or

Accepted file types: jpg, jpeg, png, Max. file size: 10 MB, Max. files: 10.

Your Sweatshirt Size:*

Please note: Israeli sizes run smaller than U.S. sizes. You may want to select 1 size larger.

Do you have your Passport information available right now?*

Yes
No

Passport Number:

Passport Expiration Date:

SIM Card Update
We provide you with a physical SIM card. Please note, not all phones have a physical SIM card slot.

Olami Terms*

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.

I agree

Mosaic Terms

Olami is funded in part by Mosaic United. Uncheck this box if you don't want to be contacted regarding future Mosaic sponsored-opportunities.

I agree

Payment Disclaimer*

Please be aware that the $499 deposit is non-refundable once payment is made. We incur significant costs for each participant, and cancellations result in substantial financial losses for us. Therefore, anyone who cancels within 10 days before the trip will be charged the full cost of the trip, which is $3,500, in addition to the non-refundable deposit. Cancellations made more than 10 days prior to the trip will result in the loss of the deposit but no additional charges. We kindly ask that you only commit if you are serious about joining the trip.

Additionally, anyone who leaves the trip early without explicit written permission from the admin prior to departure will be held responsible for the full cost of the trip. Exceptions are made only in serious life or death situations, at the discretion of the Akiva administration.

I agree

Register with Olami
https://mosaic.addapptation.com/register

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