Living Links Application 2019

Jewish Background

Name of Chabad On Campus: *

If there is no local Chabad on Campus, or you are unsure, please write that.

Rabbi/Shliach Name: *

If there is no local Chabad on Campus, or you are unsure, please write that.

Rebbetzin/Shlucha Name: *

If there is no local Chabad on Campus, or you are unsure, please write that.

Rabbi/Shliach Email

Only one email address please.

Rebbetzin/Shlucha Email

Only one email address please.

My mother is Jewish *

By birth By choice Not Jewish

My father is Jewish *

By birth By choice Not Jewish

Please explain if selecting "by choice": *

Jewish Education (check all that apply):

Hebrew School Summer Camp Day School Bar/Bat Mitzvah High School Sinai Scholars IsraeLinks

Please tell us more about your campus Jewish involvement: *

Please tell us about your other student involvement on campus beyond Judaism (ex. Student government, college Democrats, ect.) *

Essay Questions

Please write your essays in the text boxes below. We recommend you copy/paste from a separate documnet so as not to lose your essay if the application times out.

Why do you want to join this trip (min. 200 words): *

What do you hope to gain from this trip (min. 300 words): *

Upload a photo of yourself:

I understand that this program is partially funded by Mosaic United and any data on the application form, exit survey and program participation details may be submitted to them in order to receive funding. *

Confirm

My information may be used by funding partners to contact me for verification purposes. *

Confirm

I understand that Chabad on Campus may contact me for my valuable feedback as a Living Links participant. *

Confirm

I agree to permit COCI to use photos, video footage, and quotes taken within the program to be used for funding or marketing purposes. *

Confirm

I would like to receive information about other opportunities as well as marketing offered by Chabad on Campus funding partners. *

No thank you Yes please

Notes

If there is any additional information you think we may need to know, please share it here.

Living Links Registration

Home Address

School Address

Emergency Contact 1

Emergency Contact 2

Reference (not a relative)

Medical Information

Jewish Background

Essay Questions

Notes