Text Box: Please note: This application is 14 pages, and is spread out on two web-pages. Please click here for pages 7-14. Text Box:  NCSY Summer Programs Application Name of Program Applying for: _______________________________ Personal Information First Name: ________________________________________________ Middle Initial: ________________________________________________ Last Name: ________________________________________________ Preferred Name: ________________________________________________ (First name only) Date of Birth: ________________________________________________ (MM/DD/YYYY) Social Security/Social Insurance Number: ________________________________________________ Gender: ________________________________________________ T Shirt Size: ________________________________________________ Passport Information Country of Issue: ________________________________________________ Passport #: ________________________________________________ Exp. Date: ________________________________________________ (mm/dd/yyyy) Please note: Your passport MUST be valid until February 2008 or later. Contact Information Address/ Apt. number: ___________________________________________ City: ___________________________________________ State/Province: ___________________________________________ Postal Code/Zip Code: ___________________________________________ Country: ___________________________________________ Home Phone Number: ___________________________________________ (xxx-xxx-xxxx) Applicant’s E-mail: ___________________________________________ (Please note: MOST correspondence will be via email.) Participant’s Cell Phone: ___________________________________________ (xxx-xxx-xxxx) Parent’s E-mail: ___________________________________________ (Please note: MOST correspondence will be via email.) Education Current Grade: ______ What type of school do you attend? Public Yeshiva Other (Circle one) Year of High School Graduation: ____________ (Please indicate the year the applicant will be graduating from high school.) Please outline your academic history, starting with your current school. School I. (High School): ___________________________________ Grades Attended: _____________________________________ (For the above school) School II. (Middle School): _____________________________________ Grades Attended: _____________________________________ (For the above school) School III. (Elementary School):_____________________________________ Grades Attended: _____________________________________ (For the above school) Please outline your Jewish educational history if different than above. School I. (name of school): _____________________________________ Grades Attended: _____________________________________ (For the above school) School II. (name of school): _____________________________________ Grades Attended: _____________________________________ (For the above school) School III. (name of school): _____________________________________ Grades Attended: _____________________________________ (For the above school) Knowledge of Hebrew Language: None Limited I can read (circle one) I can read and translate fluent Tests and Scores Have you taken the PSAT? Yes No (Circle one) Score: _____________________________________ (If no, please write ”none”) Have you taken the SAT? Yes No (Circle one) Score: _____________________________________ (If no, please write “none”) What is your current G.P.A.? _____________________________________ Extra Curricular Activities Are you a member of NCSY: Yes No (Circle one) Please indicate your NCSY Affiliation Region: None Atlantic Seaboard Canada Central East Greater Midwest Long Island New England New Jersey New York Northwest Southern Florida Southern Southwest Upstate New York West Coast (Please indicate the region of NCSY you are affiliated with. If the applicant has not yet participated in an NCSY program before, please select "None".) Chapter: _____________________________________ Position: _____________________________________ Advisor: _____________________________________ Have you ever attended an NCSY Summer program before? Yes No I. Summer Program Attended: ______________________________________ (Name of program, Years attended) II. Summer Program Attended: ______________________________________ (Name of program, Years attended) List your membership and activities in Jewish or secular organizations: (Please include name of Org, Offices Held, Dates of Offices Held, Dates of Membership) I. Organization Info: ___________________________________________ ___________________________________________ ___________________________________________ II. Organization Info: ___________________________________________ ___________________________________________ ___________________________________________ Please list any awards or achievements you have earned: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Sports Interest Please number 1 through 10 each sport (One being the best and ten being the worst) Baseball: _____ Football: _____ Basket Ball: _____ Ultimate Frisbee: _____ Soccer: _____ Family Information Parental Status: Married Divorced Other If other, please specify: ___________________________________________ If divorced, indicate custodial parent: Mother Father Joint Salutation: Dr. Ms. Mrs. Rabbi Last Name: ________________________________________________ First Name: ________________________________________________ Address if different from application: ________________________________ (If address is the same, please write “same”) ________________________________ ________________________________ ________________________________ Occupation: ___________________________________________ Business Name: ___________________________________________ Home Phone Number: ___________________________________________ (xxx-xxx-xxxx) Cell Phone: ___________________________________________ (xxx-xxx-xxxx) Business Phone: ___________________________________________ (xxx-xxx-xxxx) Salutation: Dr. Mr. Rabbi Last Name: ________________________________________________ First Name: ________________________________________________ Address if different from application: ________________________________ (If address is the same, please write “same”) ________________________________ ________________________________ ________________________________ Occupation: ___________________________________________ Business Name: ___________________________________________ Home Phone Number: ___________________________________________ (xxx-xxx-xxxx) Cell Phone: ___________________________________________ (xxx-xxx-xxxx) Business Phone: ___________________________________________ (xxx-xxx-xxxx)