Gap Year Application

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Applicant Contact Information

Name(Required)

First Last

Pronouns

Gender

Date of Birth(Required)

Country of Citizenship(Required)

Permanent Address(Required)

Street Address Address Line 2 City State ZIP Code

Temporary Address (if different from above)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone(Required)

Mobile Phone

Email(Required)

For which program are you applying?(Required)

Spring 2026

2026 - 2027

2027 - 2028

How did you hear about Tivnu: Building Justice?(Required)

Searching Online

Social Media

Friend or Family

School

Synagogue

Youth Group

Camp

Gap Year Fair

Other

Please let us know the Name of the Person/Synagogue/Camp who referred you to Tivnu(Required)

Guardian Contact Information

First and Last Name of First Parent/Guardian(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Daytime Phone(Required)

Cell Phone

Email(Required)

First and Last Name of Second Parent/Guardian

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Daytime Phone

Cell Phone

Email

Education

Highest level of education to be completed before Gap Year Program?(Required)

High School / GED

Some time in a Four-Year College or University

Associates Degree

High School

High School Name(Required)

High School City, State(Required)

Graduation Date (Anticipated)(Required)

High School Transcript

We require an official copy of your high school transcript, current to the last grading period completed before the date of your application. The transcript may be emailed directly to Miriam@tivnu.org or attached here. If your transcript does not include attendance information, please have the school send that information, as well.

Max. file size: 50 MB.

Additional Educational Institution

Name of other educational Institution

City, State of other educational Institution

Degree/Major

(Anticipated) Graduation from other educational institution

Resume (optional)

Upload a resume in Word or .pdf format describing relevant work, volunteering, activities, or community involvement.

Accepted file types: pdf, doc, docx, Max. file size: 50 MB.

Jewish/Religious Background

How do you describe your Jewish or religious identity? (Check as many as applicable)(Required)

Applicant Health

Does the applicant take any prescription medications?(Required)

Yes

No

Please list and describe purpose(s)(Required)

Does the applicant have any dietary considerations, food or drug allergies or other medical considerations?(Required)

Yes

No

Please describe(Required)

Does the applicant have any physical or socio-emotional conditions that might affect the way they participate in the program?(Required)

Yes

No

Please describe(Required)

If the applicant has been seen by a therapist in the last year, please give your permission for Tivnu to speak with the therapist and provide contact information.

Short Essays

You may wish to draft your responses to the following questions before beginning to fill out the online application form. Please answer essays 1 and 2 and choose at least 1 of the additional essay questions to answer. For all 4 essays, you may answer in writing (up to 250 words per essay) or you may submit a 2-minute video in lieu of a written response.

1. Describe a social justice issue that is important to you, explain why you care about it, and describe any activism or volunteering you have done around that issue, or that you hope to do in the future.(Required)

2. What is your background in Jewish learning or community? What has worked for you and what has not? What aspects of Judaism or Jewishness would you like to explore? If you are not Jewish, tell us why you’re interested in a Jewish program.(Required)

Please choose at least 1 of the additional essays questions to answer. You have the option of submitting a 2-minute video in lieu of a written response.

3. Please describe with some detail two areas of your life in which you hope to grow in the coming year. How do you think the Tivnu gap year experience will contribute to your growth in each of these areas

4. Please describe one of your strengths and one challenge that you face, and how they might impact your participation in Tivnu.

5. What kind of community do you hope to find at Tivnu, and what can you contribute to building such a community?

6. A key part of Tivnu is internships at social change and nonprofit organizations. What might you get out of an internship, and what might you bring to it?

References

We will send the Tivnu reference form (DOC) to your references. These two recommenders should be adults who can offer insights into who you are, what you can contribute to Tivnu: Building Justice, and what you might gain from the program. They might know you from your involvement in school, work, volunteering, the Jewish community, or any other important aspect of your life, but they should not be relatives or close friends. Please tell your recommenders we will want them to fill out the form ASAP (within two weeks of receiving it).

Personal Reference 1

Name(Required)

First Last

Email(Required)

Phone(Required)

Relationship(Required)

Personal Reference 2

Name(Required)

First Last

Email(Required)

Phone(Required)

Relationship(Required)

Financial Aid

Tivnu is committed to making its Gap Year accessible to young adults of all economic backgrounds. Please contact Executive Director Steve Eisenbach-Budner at Steve@tivnu.org or 503-232-1864 with any questions about the affordability of the program for your family. We have always been successful in finding a suitable accommodation for every family, taking into account family finances, home community resources, and Tivnu’s commitment to an economically diverse cohort. We’re looking forward to making it work for you, too.

Are you applying for financial aid for the Gap Year Program?(Required)

Yes

No

Financial Aid Application Link

Financial aid applications are due with your program application. We prioritize early applications for tuition assistance. Click here for the application, and please use the school code 201518. The National Association of Independent Schools (NAIS) has excellent customer support and is available to help you through the process: call them at 800-344-8328 for support. If you will be requesting tuition assistance, please also send a copy of your W2 and 1040 forms to Executive Director to Steve@Tvinu.org by the time you submit this application.

Gap Year Program Application Fee(Required)

I will submit the $72 application fee immediately after submitting this form (payment processing occurs in a separate window)

Terms

Applicants will not be considered until all application materials have been received. Receipt of application materials and deposit does not guarantee acceptance to the program. Tivnu: Building Justice reserves the right at any time to accept, accept with conditions, or revoke acceptance of any applicant, in its sole and absolute discretion. Participation in Gap Year Program is contingent upon completion of additional documents to be provided at a later date: 1. Tivnu Medical Certification including a Personal Medical History form that you must fill out and a Physical Examination form that a primary care provider must complete and sign 2. Agreement to and signatures on "Tivnu: Building Justice Gap Year Program--Rights and Responsibilities" and “Family contract.” These documents outlines the communal expectations, policies, procedures, and rules applicable to full participation in the Gap Year Program.

Agreement(Required)

By submitting this form, I certify that, to the best of my knowledge, statements I have made in this application are completely true.

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Application

To complete this application, you will need to provide the following:

1. Basic Information:

2. Short Essays:

3. References:

4. Fees and Financial Aid: