ADMIN

Tour ID

MM/DD/YYYY

Country of Birth

PERSONAL | CONTACT INFO

###-###-####

Country

State

Provinces

Please tell us how you heard about Momentum

WhatsApp	Facebook
Email	Flyer
Friend/Relative	Local outreach or learning center
Local synagogue	Momentum website
Past participant	Web search engine
Other

Other

Please name who referred you

SPOUSE/PARTNER| INFORMATION

Marital Status

Are you Jewish?

YesNo

Are you a Momentum trip alum?

YesNo

If you have children, how many do you have

Please tell us more about your children starting with the youngest first:

Child 1	Gender	Date of Birth
Child 2	Gender 2	Date of Birth 2
Child 3	Gender 3	Date of Birth 3
Child 4	Gender 4	Date of Birth 4
Child 5	Gender 5	Date of Birth 5

Why is it important for you to take part in a Momentum Grand trip?

Have you previously been involved with Momentum? If so, please describe.

What are your philanthropic interests?

Please tell us more about your background and what you hope to gain from the Momentum Grand trip:

BACKGROUND | JEWISH ACTIVITY

What activities, hobbies, and organizations (including Jewish organizations) are you involved in? Please describe your participation in them.

How often have you volunteered for a Jewish organization in the past?

WeeklyMonthlyA few times a yearRarely, if ever

Have you held a professional role in a Jewish organization in the past ten years?

YesNo

Have you attended a Jewish conference in the past five years?

YesNo

In which organizations do you participate and what is your role (volunteer, board member, etc)?

Which organizations are you involved with? (select all that apply)

AIPACHadassahJewish Community Centers Association of North America (JCCA)Jewish FederationJewish Funders Network (JFN)Jewish National Fund (JNF)YPOOtherNone

Other organization(s) you are a member of:

Do you have any accessibility requirements or physical limitations or restrictions?

YesNo

Please elaborate on your requirements, limitations, or restrictions:

After submitting this form, you will receive an automatic email confirming the receipt of your application. Please contact us if you do not receive this email at info@momentumunlimited.org