Ulpan Kibbutz Sde Eliyahu

Address: D.N. Beit Shean

Israel 10810 00

Email: ulpan@sde1.org.il

Phone and fax: 972 46096531

Cellphone: 972 54 3028455

 

Contact Information

In order to register, please fill out the following form in its entirety & send it to the Ulpan management. (* = required field, * = error in field)

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Last Name:

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First Name:​

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Father's Name:​

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Mother's Name (including maiden):​

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Sex:​

male
female

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Date of birth:​

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Place of Birth:​

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Present Citizenship:​

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Home Address (Abroad/Parents):​

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Home Address (if in Israel):​

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Marital Status:​

Single
Married
Divorced
Widow/er

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Contact Telephone:​

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E-mail:​

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Profession:​

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Did you finish High School ?​

yes
no

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Name of High School:​

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Academic Degree:​

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Current Health Status:​

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Previous Health History:​

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Disabilities:​

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Current Medications:​

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Mental Health History:​

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Learning Disabilities:​

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Languages spoken:​

English
French
German
Spanish
Russian
Portuguese
Yiddish
Other

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Hebrew Speaking Level:​

Nothing
Poor
Fair

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Hebrew Writing Level:​

Nothing
Poor
Fair
Good
Excellent

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Immigration Status at Ulpan Arrival:​

Immigrant
Tourist_Visa
Returning_Citizen

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Religion:​

Jewish
Christian
Muslim
Other

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Previous Religion:​

Jewish
Christian
Muslim
Other

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Mother's Religion:​

Jewish
Christian
Muslim
Other

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Father's Religion:​

Jewish
Christian
Muslim
Other

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Aliyah date and/or arrival to the Ulpan:​

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Name and E-mail of Rabbi​

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Name and E-mail of Shaliach:​

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Do you know anyone who was on the Ulpan?​

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Comments:

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Semester interested in Joining:​

August 2017
March 2018

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קיבוץ שדה אליהו