Application/College Women

Scholarship Application Form

To be considered a candidate, complete this online form, then submit and pay your $50 application fee. Have your letter of recommendation sent to students@snorkelandstudy.org

Make sure to set aside ample time to provide thoughtful answers to the questions below.

**IMPORTANT! If you submit your application and receive an ERROR message, SCROLL DOWN. You will find your application below the error message. The missing field will be highlighted in RED. Complete the missing information and then resubmit.**

Check here to be considered for a scholarship. We’ll use this same form to evaluate your award.

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First Name *

Last Name *

Hebrew name, if known

Mother's Hebrew name, if known

School *

Major *

Year in School

Permanent Address *

City *

State

Zip *

If outside the USA, please enter State/Province here

Country *

Home Phone *

School Address *

City *

State *

Zip *

If school is outside the USA, please enter State/Province here

Country of School *

Cell Phone *

Email Address *

Date of Birth *

Name and contact number of the person who referred you:

Name of person who referred you *

Phone of person who referred you *

Please answer the following questions.

1. What are your hobbies, interests, clubs, volunteer experiences? *

2. What is your previous Jewish education, if any, ex: Hebrew School, classes or Shabbat at Chabad, etc *

3. How would you rate your Hebrew on a scale of 0-10, where 10 is most proficient. *

4. Write two to three paragraphs about 1, your most memorable Jewish experience; or 2, an individual you know who represents Judaism or Jewish values. *

5. Write one to two paragraphs describing what you hope to gain by attending. *

Do you have any medical, dietary, or other needs? *

Do you have any allergies, including penicillin? *

Please list any medications you’ll be taking during the trip. If there are none write none. *

Do you have any restrictions on activities? *

Are you converting? If so, please give us the name and number of your rabbinic contact.

Is there anything else you want us to know about you?

Emergency Contact Name and Number

Emergency Contact Name *

Emergency Contact Phone *

I give permission to Bais Chana to use photos or video of me in their promotional materials

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Scholarship Application Form