Student Application

Name

Gender Male Female

Address (School)

Address (Home)

Phone Number

E-mail

University currently attending

Year in School

Age

Major/minor

What is your level of Jewish observance? Reform Conservative Orthodox Other (please explain) Do you keep Kosher?

Do you have a car or are you willing to use public transportation to see your Pittsburgh family? Yes No

If you have a car, are you willing to drive to see your Pittsburgh family, such as a family in the suburbs? Yes No

Do you have any pet or food allergies? Yes (please explain) No

Which activities are you most interested in doing with your family? Mostly Jewish Secular Both

Please write a few sentences about your interest in and expectations for this program.

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