Maimonides Application
Introductory information
* First Name: 
* Last Name: 
* Gender: 
* Date of Birth:       
* What University are you currently attending?: 
* Name of Maimonides campus you wish to attend: 
Your Address at School
* Address 1: 
Address 2: 
* City: 
* Country: 
* State / Province: 
* Zip / Postal Code: 
Telephone: 
* Cellphone: 
* Email address: 
* How would you describe your Jewish affiliation?
* Is your mother Jewish?
* if yes,
* Is your father Jewish? 
* if yes,
Are these your birth parents?
If no, please explain:
Please list the names and ages of your siblings:


Do you have any special medical needs?
Explain:
If you are taking, or have taken in the past (on a protracted basis) any medication for any aspect of your health, please indicate:
 
Education:  
* What was is the highest level of Jewish education you've completed?
Describe your Jewish educational background (if any):
If so, what year?
* How would you describe your level of Hebrew proficiency?
List chronologically all the schools you have attended:
Name of School
Secondary Schools
Location
Dates of Attendance
Graduation Date and Degree Awarded
Jewish Schools
(if not included above)
Location
Dates of Attendance
Graduation Date and Degree Awarded
College or University
Location
Dates of Attendance
Graduation Date and Degree Awarded
* In two paragraphs, please explain what you hope to gain from the Maimonides Leaders Fellowship program.
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.

Be sure you have selected the correct school in order for the appropriate representative to receive your application

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