ALIYA B’SIMCHA GARIN ALIYA NO.1
A New Style of Absorption in the Shomron

c/o Eric Wiseberg, Maale Levona, DN Efraim, 44825 Israel
Fax: +972-2- 940-9454 Ph: +972-2-994-1497 Email: eriklita@netvision.net.il

Application Form

For __________________________ Family

Anticipated date of Aliyah ____________________

Possible Area for Direct Aliya in : Binyamin___ . Shomron____ . Yehuda____.Gaza Strip ___.
(Please say “Yes” or “No”,even to more than 1)

Prefer Large (over 150 Families) / Small Community(under 150 Families)

Prefer Community which is : Totally Religious___ Charedi____ Non-Religious ____ Mixed______

Telephone ________________ Fax_________________Email ________________

Address __________________________

City ___________________ State ___________ Zip/Mail Code ______________ Country _____________________

Husband's Name___________ Date of Birth __________ Profession_________________Education____________________________

Do you want to learn Hebrew in an Ulpan?

Current Level of Hebrew ___None ____Weak __Good ___Fluent

Wife's Name ______________ Date of Birth_______________ Profession_________________Education_____________________________

Do you want to learn Hebrew in an Ulpan?

Current Level of Hebrew ___None ____Weak ___Good ___Fluent

Date of Marriage _______________ Place of Marriage ___________________

Names of Children Date of Birth Grade for coming year 1. 2. 3. 4. 5.

Full Name of Rabbi____________________________ Address____________________________________________________________ Phone_________________ Fax __________________ Email __________________

Full Name of your Shaliach ______________________________________________ Address____________________________________________________________ Phone_________________ Fax __________________ Email __________________

Please attach recommendations.