Programs


Livnot's Year-round Volunteer Program - Application Form

Interested in volunteering? Please send us your contact information on the form below or call our New York office at 1-718-247-4442 and we will be in touch with you as soon as possible.

  • Additional medical insurance may be purchase at the cost of $7 - $11 USD per week depending on type of coverage, age of insured etc.
Note: Fields marked with * are required.
* Planned Arrival Date:
* Planned Departure Date:

General Information

Please enter your legal name as it appears on your passport.
*
First Name:
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Last Name:
 
Hebrew Name:
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Gender:
Male Female
Passport Number:
* Date of Birth:
* Marital Status: Single     Married     Divorced    Widowed
Permanent Address
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Street:
*
City:
*
State:
*
Zip:
*
Country:
*
Phone:
 
Cellphone: (If you are currently in Israel, please include your Israeli cell phone number or other number to reach you at)
 
Fax:
*
Email (main):
*
Confirm Email (main):
 
Email (secondary):

Tell us about yourself

 

Occupation:

* Religious Affiliation:
* Have you ever been to Israel before? No    Yes
  Purpose of trip, dates and duration:
  Level of Hebrew: None    Basic    Moderate    Fluent
* Have you ever done volunteer work in Israel?
* Have you ever done a Livnot program?
* Do you have family or friends currently living in Israel?
* Are you involved with the Jewish Community now?
* Will you require housing on our campus?
* What kind of volunteer work would you like to do?
  Comments:
* Volunteer work can be physically and/or emotionally demanding. Do you have any condition, physical or otherwise, that we need to know about?

Please provide emergency contact

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First Name:
*
Last Name:
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Address
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City
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State
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Zip
*
Country
*
Phone
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Email
*
Type of relation
   
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We suggest you check the information that you have filled out, is correct, before submitting it to us. Thanks!