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Maimonides PRO Application

First Name *

Last Name*

Gender*

Date of Birth (MM/DD/YYYY)*

Age*

What Univeristy are you currently attending?*

Street Address*

City*

Province*

Postal Code*

Phone Number*

Email address:*

Is your father Jewish?*

Born Jewish

Converted

No

Is your mother Jewish?*

Born Jewish

Converted

No

Are these your birth parents?*

If no or if either parent converted, please explain:

Do you have any special medical needs?

If you are taking, or have taken in the past (on a protracted basis) any medication for any aspect of your health, please indicate:

How would you describe your Jewish affiliation?

What was is the highest level of Jewish education you've completed?*

Describe your Jewish educational background (if any):

In two paragraphs, please explain what you hope to gain from the Maimonides II 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.

A branch of Aish Toronto and AishCampus