Dr. Beth Samuels Summer High School Program

Use this form to apply to the Dr. Beth Samuels Drisha Summer High School Program. In 2024, the program will run from June 25th through July 25th. Join other teen girls from around the world for over a month of intense Torah study, every form of campy fun, and wonderful relationships that will last a lifetime. Please note that this application is the first step in the process. You will also need to have two unrelated adults who know you well (such as teachers or clergy) submit recommendation forms, and then you will complete an interview with the program director.

Applicant Information

In this section we will ask you for some basic information about you.

Name *

First

Last

Nickname

If you don't go by your full legal first name, please tell us what you prefer to be called, whether it's a shortened form of your first name, your middle name, Hebrew name, or something unrelated that just stuck!

Email *

Applicant Photo *

Click or drag a file to this area to upload.

Please attach a nice photo of yourself. This does not need to be a formal headshot, selfies are fine!

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

Please provide us with at least one phone number!

Cell Phone

Please provide us with at least one phone number!

Place of Birth *

Date of Birth *

Parent/Guardian Information

In this section we will ask you for some basic information about the adults who are responsible for your wellbeing.

Parent or Guardian A

Name of PG-A *

First

Last

Relationship to applicant of PG-A *

Cell Phone of PG-A *

Email of PG-A *

Occupation of PG-A

Parent or Guardian B

If you have only one parent or legal guardian, please use this section to provide information for a second trusted adult who can serve as an emergency contact.

Name of PG-B

First

Last

Relationship to applicant of PG-B

Cell Phone of PG-B

Email of PG-B

Occupation of PG-B

Relationship of parent(s)/guardian(s) to each other

e.g. Married, widow(er), divorced, etc.; we ask this to help understand your network of care and make sure that we communicate respectfully with everyone in our community

High School Information

Let us know where you're going to school and when you're hoping to graduate!

High School Name *

Current Grade *

Which grade will you have just completed when you join us this summer?

Expected High School Graduation Year *

Recommenders

Please list the names and email addresses of two adults who are not your relatives, but who know you well. Typically, your teachers, rabbis, or religious school faculty and staff make the best recommenders.

Name of Rec-A *

First

Last

Relationship to applicant of Rec-A

Email of Rec-A *

Name of Rec-B *

First

Last

Relationship to applicant of Rec-B

Email of Rec-B *

Written Responses

All Schools *

List all elementary, middle, and high schools attended including supplementary schools of Jewish studies. For each, please list the school, location, and years attended.

Selected Extracurriculars *

List major extracurricular or communal activities in which you participate with special attention to Jewish-related activities.

Special Circumstances

Please describe any special circumstances, conditions or information that should be taken in to account in considering your application.

Personal Statement *

Click or drag a file to this area to upload.

Please upload a written personal statement of approximately of 300-500 words addressing one or more of the following topics: (a) why you hope to join the Dr. Beth Samuels Drisha Summer High School Program (b) your favorite Torah text or study topic (c) your favorite Torah study experience.

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