Youth Application Form

March of the Living Youth Delegation Application Form

Please complete the application form below. Note: partial forms cannot be saved.
It is recommended for applicants to prepare their motivational answers in a word document beforehand, so that they can be easily copy-pasted to the form.

1. Applicant Information

Full Name (As Shown on Passport) *

High School *

Physical Address *

Postal Address *

Phone Number (Home) *

Email (Important - all communications will be sent here!) *

Additional Emails (Optional) *

Phone Number of Applicant (Cell) *

2. Passport Information

Citizenship(s) *

Date of Birth (DD/MM/YY) *

Gender *

Female Male

Passport Number *

Country *

Expiry Date (DD/MM/YY) *

Additional Passports Information *

3. Emergency Contact

Name *

Phone Number *

Relationship to Applicant *

4. Health History

Are you generally in good health? (If no, please elaborate) *

Are you taking any medication? *

Do you suffer from any allergies? *

Describe any physical handicaps, restrictions or disabilities you may have *

Have you ever been in any kind of therapy (physical, psychological, social or other) ?
If so, please indicate below. All information will be kept strictly confidential.

Name of person consulted *

Profession *

Dates of Consultation *

Reason for therapy *

Have you suffered a significant loss? Please describe. *

5. Personal Profile

Are any of your family survivors of the Holocaust? If yes, please list: *

Did any of your relatives perish in the Holocaust? If yes, please list: *

Why do you want to participate on the March of the Living? (please provide as detailed a response as possible): *

What do you think you can contribute to the programme and the group? *

This programme necessitates participants with a high sense of maturity and sensitivity. Please indicate that you understand that rooming assignments will be allocated at the staff's discretion: *

Do you require financial assistance for the programme? (*Please note that we have limited subsidy packages available based on need) *