Wufoo
MZ Teen - iConnect with Israel
Join over 100 teens from across North America for a unique opportunity to deepen your knowledge about contemporary Israel, build community, enhance leadership skills, and develop a strong voice in support of Israel.
Learn about Israel engagement opportunities on college campuses by meeting with current student leaders and other Israel related organizations.
Explore Israel's contributions to the world in the areas of innovation, and experience cutting-edge Israel resources that you can bring back to your peers and communities.
When:
Friday, March 30th - Sunday, April 1st
Where:
Capital Camps & Retreat Center
in Waynesboro, PA
Price:
$125 participation fee. Flights, lodging and food are included.
Please contact
Aliza Goodman
for more information about the program or about subsidies.
Application Deadline:
Applications are now being accepted on a rolling basis.
Spots are limited, so sign up now!
This gathering is being hosted by the
MZ Teen Israel Internship
, made possible with the generous support of the MZ Philanthropic Fund, and supported in part by a special grant from the AVI CHAI Foundation and the Charles and Lynn Schusterman Family Foundation.
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Personal Information
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Parent/Guardian Information
3
About Your Israel Experience
4
Short Answer Questions
Name
*
First
Last
Email
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Democratic Republic of the Congo
Republic of the Congo
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Home Phone Number
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Cell Phone Number
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Date of Birth
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MM
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DD
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YYYY
Gender
*
Male
Female
High School
*
All meals will be Kosher.
Please indicate any special dietary restrictions.
Rooming Preferences:
*
I'd prefer to room with someone who keeps Shabbat.
I'd prefer to room with someone who does not keep Shabbat.
I have no preference.
Roommate Request:
Please list only one person.
Roommate requests are not guaranteed.
How did you hear about iConnect with Israel?
*
Friend (from school, youth group, etc.)
Current MZ Teen
Facebook
Youth advisor/other professional
Synagogue or Temple
Other
Name of person who referred you to iConnect with Israel (if applicable):
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