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Program location:
Which Aish ReMix Program would you be able to attend?
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Manhattan
Queens
Albany
On which days would you be able to attend? (Session is between 7:30 PM and 10:00 PM.)
Sunday
Monday
Tuesday
Wednesday
Thursday
Contact Information:
First Name:
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Last Name:
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Email Address:
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Phone Number
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Date of Birth:
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MM
01
02
03
04
05
06
07
08
09
10
11
12
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
Gender:
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Please Select
Male
Female
Have you been with us before?
Have you been on an Aish trip before?
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Please select...
Yes
No
Which program(s) have you attended?
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Prague/Israel
MetroFest
Winter Rush
Fabulously Feminine
Xtreme
Enterprize
London/Israel
Aish Cafe
Other
Which other trips have you attended?
Parent's Infromation
Residence of:
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Self
Parents
Address:
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City:
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State:
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Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
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Country:
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Home Phone:
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School Information:
University/College
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Please Select
Adelphi University
Barnard
Columbia
CUNY-Baruch
CUNY-Brooklyn
CUNY-City College
CUNY-Hunter
CUNY-John Jay
CUNY-Kingsborough
CUNY-LaGuardia
CUNY-Lehman
CUNY-Queens
CUNY-Queensborough
CUNY-Staten Island
CUNY-York
Fashion Institute of Technology
Fordham University
Hofstra University
Long Island University
Long Island University - C.W. Post
Long Island University-Brooklyn Campus
Montclair State University
Nassau Community College
New York City College of Technology
New York Institute of Technology
New York University (NYU)
Pace University
Rutgers
Sanford Brown Institute of NYC
Stern
St. John's University
SUNY-Albany
SUNY-Rockland
SUNY-Stony Brook
Touro
Touro College/Flatbush Campus
YU
other
What is your college?
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Year of graduation:
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Please Select
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Personal Information:
How did you hear about the program?
Was your father born Jewish?
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Please select...
Yes
No
Summarize Conversion History, if any:
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Was your mother born Jewish?
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Please select...
Yes
No
Summarize conversion history, if any:
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What Jewish Education have you had?
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Please Select
None
Hebrew School
Hebrew High School
Yeshiva
Your current Jewish affiliation:
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Please select...
Reform
Conservative
Orthodox
Unaffiliated
Other
Describe your academic interests, hobbies and extra-curricular activities:
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Do you hold any leadership/professional positions in Jewish organizations?
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Please select...
Yes
No
Which ones?
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What do you hope to gain from the Aish ReMix program?
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