First Name		Last Name
Date Of Birth		Gender	Please select... Male Female
Are you currently a student	YesNo	Which school
Email (must be a non.edu account)		Email 2
Phone		Cell
Address		City
State:	Please select... AA AE AP Alabama Alaska Alberta American Samoa Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana N.W.T. Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Islands Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Island Virginia Washington West Virginia Wisconsin Wyoming Yukon Outsite the US	Zip
Are you Jewish?	YesNo	Which of your parents are Jewish	Please select... Mother Father Both Neither
I consider myself:	Please select... Conservative Orthodox Reform Reconstructionist Just Jewish Other	Are there any conversions in your immediate family?	Please select... Mother Father Both None
Have you been on Taglit-Birthright Israel trip?		YesNo
If yes, which provider did you come with?
Season I am interested in recruiting/staffing for:		Please select... Summer 2017 Summer 2018 Winter 2018-19 Summer 2019
I will be recruiting for:		Please select... My School Independently
Should you be chosen to join a Mayanot trip this upcoming season which dates would you be available to travel? (Please ignore the number following each date. All you need to do is choose all the dates you can travel.)
Have you previously staffed a Taglit - Birthright Israel Program?		YesNo
If yes, which provider did you staff with?
How many times have you previously been to Israel:		Please select... 1 2 3 4 5+
Please indicate the context of your previous Israel Trips:		Please select... Taglit - Birthright Israel Israel travel program Israel study program High School / Youth Group Semester or Year in Israel Volunteer Program Visit with family March of the Living Other
If other:
Please indicate theoretical or practical experience you have had in areas working with young people:		Please select... Youth Group advisor Hillel/Chabad/Campus Staff Camp Staff Jewish Communal Professional Courses in Education or social work Rabbinic or Jewish Education degree Leadership position in Jewish organizations or movements Other
If other:
Please indicate Basic Jewish / Israel related education you have as evidenced by:		Please select... Youth Group advisor Graduate of Day School Jewish High School Jewish Studies courses at University Participation in adult Jewish study institutes, seminars, workshops Other
If other:
What is your level of Hebrew?		Please select... None Poor Basic Good Fluent
Are you in a fraternity/sorority?		YesNo
Which one:
Are you a photographer/videographer/journalist?		YesNo
Please write one paragraph to explain why you believe you are qualified to lead a Taglit - Birthright Israel trip: (minimum 300 characters)
Do you agree to the Recruiter Guidelines		Please select... Yes No
How did you hear about this opportunity?		Please select... Mayanot trip in Israel Mayanot Email Mayanot Mail Campus Rabbi Friend Other
Your Recruiter Code: Please enter your cell phone number. This is your personal recruiter code which people should use to sign up under your name. Only those applications with your complete cell phone number and name in the Referral Code field (on the Date Request Form of the MAYANOT application) will be counted towards your total.
Please enter your facebook link:
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