Application Form- Spring Break: Berlin 2017

Thank you for interest in joining the Illini Chabad on Campus Alternative Spring Break trip to Berlin.

Please note that seats are limited and applying does not guarantee you a spot on the trip.

You will be notified via e-mail when you are accepted. Acceptance emails will be sent by Tuesday December 31 at the latest.

Once accepted, you will have 48 hours to submit the non-refundable trip fee; we will not be able to hold your spot after that.

First name:
Last name:


Gender: Female Male
Graduating year: alumna/us
Permanent Address:


City State Zip Country

School Address:

  City State Zip
Mobile Phone:
Permanent Phone:
Date of birth:
Emergency Contact 1:  

Emergency Contact 2:  
Do you have a valid Passport that does not expire before June? Yes No
Are you an American citizen? Yes No, Country
Do you speak German or Russian? No Yes I Only understand
Please describe your Jewish educational background, if any,
(ex: Hebrew School, Judaism 101, classes at Chabad, etc?)
What is your main objective(s) in attending Chabad's ASB Trip?
Described any leadership eperience you have
Please describe any medical conditions
Do you have any special dietary or other needs?
Do you have any alergies?

No Yes

Will you be taking any medications during the trip? No Yes
Do you have any accessibility requirements or physical limitations/ restrictions? No Yes
Please list any prior social action trips you've joined
Please describe any experience in social work

I heard about this trip from:


Please send me information about Chabad's upcoming summer trip to Israel. Participating students will have the opportunity to participate in exciting classes led by renowned lecturers, learning about Israel, the past, present and future.

I understand the responsibilities of joining a group community service trip, and I pledge to participate in all programs on the ASB and pre & post trip events. I will pay the fee of $1250 (plus $250 for Prague) upon acceptance to the program.

I Understand that I will be required to participate in all fundraising efforts for this trip. With a commitment of raising $1000.

I agree to a post trip (20 minute) interview and/or
a 2 page paper to give my impressions and thoughts on the experience. (a requirement in order to be accepted)

Note: Application is not a guarantee of acceptance. You will be notified of your acceptance by Tuesday December 31 at the latest. You will then have 48 hours to submit the non-refundable fee, at which point travel arrangements will be made.

*Note the trip actually costs close to $2750 per student, The rest will be subsidized. We will also do events together to help raise funds.