icnext 14 REGISTRATION FORM

Please complete the form below. Required fields marked with an asterisk *

ICNEXT 14 REGISTRATION FORM

STUDENT INFORMATION

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Date of Birth*

Answer required for "Date of Birth"

Grade as of September 2025*

Answer required for "Grade as of September 2025"

Student Phone*

Number Required

Student Email*

Answer required for "Student Email"

Student School*

Answer required for "Student School"

Synagogue *

Answer required for "Synagogue "

PARENTS INFORMATION

Parent 1 First Name*

Answer required for "Parent 1 First Name"

Parent 1 Last Name*

Answer required for "Parent 1 Last Name"

Parent 2 First Name*

Answer required for "Parent 2 First Name"

Parent 2 Last Name*

Answer required for "Parent 2 Last Name"

Parent 1 Phone*

Number Required

Parents 2 Phone*

Number Required

Parent 1 Email*

Answer required for "Parent 1 Email"

Parents 2 Email*

Answer required for "Parents 2 Email"

Address*

Answer required for "Address"

City*

Answer required for "City"

State*

Answer required for "State"

Zip Code*

Answer required for "Zip Code"

In Case of Emergency, Person to Contact (If Not Parents)*

Answer required for "In Case of Emergency, Person to Contact (If Not Parents)"

EXTRACURRICULAR ACTIVITIES

List Your Extracurricular Activities. Include and Describe Your participation In Pro-Israel Activities In Your Community, At Your School, Youth Movement Or Synagogue*

Answer required for "List Your Extracurricular Activities. Include and Describe Your participation In Pro-Israel Activities In Your Community, At Your School, Youth Movement Or Synagogue"

Have You Been To Israel Before? If Yes, When and With Whom?

Answer required for "Have You Been To Israel Before? If Yes, When and With Whom?"

Are You Currently Writing For Your School Or Community Newspaper? If Yes, Please Paste Sample Here (or attached a file bellow):

Answer required for "Are You Currently Writing For Your School Or Community Newspaper? If Yes, Please Paste Sample Here (or attached a file bellow):"

(If needed) Upload pdf scanned copy of Written Sample

Answer required for "(If needed) Upload pdf scanned copy of Written Sample"

Choose a file or drag it here.

Please List 2 Reference: One Academic and One Personal (Name, Phone and email For Each)*

Answer required for "Please List 2 Reference: One Academic and One Personal (Name, Phone and email For Each)"

ICNEXT 14 TENTATIVE SCHEDULE:

Meeting 1: October 19, 2025

Meeting 2: November 23, 2025

Meeting 3: December 14, 2025

icnext Day of Service: Monday, January 19, 2026 (MLK Day)

Meeting 4: January 25, 2026

Meeting 5: February 8, 2026

icnext Mifgash with TeenShinim: Sunday, March 8, 2026

Meeting 6: March 15, 2026

Meeting 7: April 12, 2026

Meeting 8: May 17, 2026

Israel Mission: June 7-18, 2026

Reunion: Sunday, August 30, 2026

Year 2 First Semester Meeting: October 18, 2026

Year 2 Second Semester Meeting: February 21, 2026

Please fix the highlighted areas below before submitting.

icnext 14 REGISTRATION FORM