1. Applicant Information

The decision to participate on Temple Shaaray Tefila's Annual Nicaragua Service Learning Trip is not an easy one. You will be living and working in a VERY materially poor community with conditions VERY different from your own. You will be expected to fully participate in every aspect of the program; from the sometimes difficult and strenuous labor to engagement with the community. It is a hard journey but one definitely worth taking. . .

All information below will be kept private and not shared.
The only way to save your answers is to make sure your computer's cookies are enabled and click "next page" on the survey. Most computers cookies are already enabled. However, it may be best to set aside time to answer all the questions in one sitting. If you have a question about this or anything pertaining to the survey, please feel free to contact Brad Zicholtz, Director of Experiential Education - 914-307-0465

* 1. Applicant Information

* 2. Grade and School (If adult, please indicate.)

* 3. Parent's Email Addresses

* 4. Parent's Cell Phone

* 5. Have you previously been on a Temple Shaaray Tefila Nicaragua Service Learning Trip?

* 6. What participant(s) would you like to be with? *We will be split up amount 3 communities. There is no guarantee who you will be with but this will assist us in determining the groups.