Twin Cities JSU Project Impact Chicago Application Form

MPLS JSU Project Impact New York Application Form

Please use this form to apply for our Project Impact New York Retreat for Jewish 9th-11th grade teens over MLK Weekend, January 16-20! The cost of the trip is $499.
Over this weekend, we will volunteer with and learn about various incredible Jewish "Chesed" (Kindness) Organziations, tour New York and connect with each other as we experience an inspirational Shabbat together. Hang out with friends, meet awesome advisors and enjoy great activities! Teens will also earn up to 10 service hours!

A deposit of 50% of the cost of the trip must be made to reserve your spot by 3 weeks before the trip, December 26. Full payment must be made two weeks in advance, by January 2. Participants who withdraw before January 2 will only receive a 50% refund but will be able to use the other 50% towards a future NCSY/JSU event. Participants who withdraw after January 2 will not receive a refund but can use 50% of the funds paid towards a future event.

Full Legal Name of Participant*

First Last

Birthdate of Particpant*

Participant Phone Number*

Participant Email*

Participant Grade*

9th
10th
11th
12th

Participant School*

Parent Name*

First Last

Parent Email*

Parent Cellphone Number*

In a few sentences please write why you would like to go on this retreat?*

What is your sweatshirt size?*

Small
Medium
Large
XL

What are your summer plans? (Your answer will not impact acceptance.)*

I have read and agree to NCSY/JSU's refund policies.*

Confirmed

Signature*