JFS - Semester Program Step 1 of 6 - Basic Information 16% For which program would you like to apply?* Fall Semester 2020 (Sept. 1 - Nov. 30) - 8400 USD Spring Semester 2021 (Jan. 28 - April 28) - 8400 USD Fall Semester 2021 (Sept. 3 - Nov. 26) - 8400 USD Name* First Last Date of Birth Date Format: MM slash DD slash YYYY Country of CitizenshipAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Email* Please upload a passport style photograph Save and Continue Later Academic InformationName of academic institution currently attending or last attended (Name, State, Country)*Year Completed Date Format: MM slash DD slash YYYY Please leave blank if still enrolledCourse of Studies* Please briefly describe area of study, number of credits, or degree earned.Other institutions?YesNoAcademic Institution #2Name of Academic Institution*Year Completed Date Format: MM slash DD slash YYYY Please leave blank if still enrolledCourse of Study* Please briefly describe area of study, number of credits, or degree earned.Other Institutions?YesNoAcademic Institution #3Name of Academic Institution*Year Completed Date Format: MM slash DD slash YYYY Please leave blank if still enrolled.Course of Study* Please briefly describe area of study, number of credits, or degree earned. Save and Continue Later Please identify any pre-existing medical conditions. Allergies Inflammatory Disease Amoebic Dysentery Asthma Diabetes Epilepsy Foot or Leg Conditions Gastro-Intestinal Disease Hepatitus High Blood Pressure HIV/AIDS Hypertension Hypoglycemia Kidney Condition Learning Disability Malaria Mental Health / Disorder Migraine Headaches Mononucleosis Nervous Disorder Paralysis Pneumonia Rheumatic Fever Substance Abuse Tuberculosis Have you ever been under the care of any mental health physician?* Yes No Please explain.Are you receiving medication or physician's care for any medical conditions?* Yes No Please explain.Do you have any previous history of substance abuse or mental illness?* Yes No Please explain.Are you allergic to any medication or foods?* Yes No Please explain.Do you have any dietary restrictions?* Yes No Please explain.Are there any other medical conditions or information that we should know about you?* Yes No Please explain.In Case of Emergency* I give permission to a JFS representative in Israel to select a physician, to hospitalize, to secure proper treatment, to order injections, anasthesia, or surgery for me. Save and Continue Later References*Please provide two or three references who are not close relatives.NameRelationshipPhone Number Why would you like to study in Jerusalem?*What kinds of books do you like to read?*Tell us about a book or movie you've read or seen recently and what you liked or disliked about it.* Save and Continue Later Liability Waver* I agree.On my behalf and on behalf of my heirs, executors, personal representatives, contractees and employees, I hereby release and forever discharge Jerusalem Field School, their officers and employees from any claim for loss, death, disability, delay, or damage to person, property, or for accident or illness howsoever arising which may be suffered by me or by anyone claiming though me, during the period of, in consequence of, or in any way related to the work and/or study undertaken by me in connection with my participation in this Project.Standard of Conduct* I agree.The undersigned acknowledges the right of the Jerusalem Field School (JFS) to remove anyone from the program if their conduct does not meet the standards established by JFS. JFS does not assume any financial obligation to refund the cost of the program or any expenses associated with travel or lodging because of an early dismissal. Save and Continue Later Registration Fee*RegistrationCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.