DiscoverU

Basic Info

First Name

Last Name

Address

City

Zip

Home Phone

Cell Phone

Gender
Male Female

Religous Affiliation
Born Jewish Converted Not Jewish

Date of birth

Allergies

Medications & Reason taken

Any history of anxiety, depression and/or eating disorders?

Upload photo of yourself
Browse

Schooling Info

Current School

Years Attended

Previous School

Years Attended

Any other previous schools?

Camp names & years attended

Are you currently employed?
Yes No

Are you returning from Israel?
Yes No

Plans for next year
Work College/Seminary Other

References

List 2 names and numbers of teachers/principal who currently know you well.

Reference 1

Name

Phone

Relationship

Reference 2

Name

Phone

Relationship

Camp Info

Choose a Session

Session A Session B Session C

Refered by

Name

Phone Number

Other friends attending

Will you be applying for an Israel Scholarship?
Yes No

Emergency Contact

Contact Name

Contact Number

By submitting this form, you agree to get communications on the contact info you provided above.

For financial assistance, fill out our Scholarships application.

Ready?Apply Here

Basic Info

Schooling Info

Family Information

Father's Info

Mother's Info

References

Reference 1

Reference 2

Camp Info

Choose a Session

Refered by

Emergency Contact

Explore

General Info

Next Steps

Our Affiliates