ICNEXT 15 APPLICATION FORM

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ICNEXT 15 APPLICATION FORM

This affordable 10-day trip explores Israel from Jerusalem’s cobblestone streets to Tel Aviv’s cutting-edge graffiti. Participants will gain deeper knowledge of Israel-related issues while creating lasting memories, traveling with this year’s Cleveland Shin Shinim and connecting with teens from Beit She’an.

The actual cost of the icnext experience is approximately $9,000 per student, but it is heavily subsidized through generous support from the Jewish Federation of Cleveland’s Campaign for Jewish Needs, bringing the family cost down to $2,500 per student. This fee includes programming for both Year 1 and Year 2, administrative costs, flights, hotel, all meals, and the Israel experience. $700 of the $2,500 fee is non-refundable. All participants are eligible to use the Jewish Federation of Cleveland’s “Gift of Israel” one-time scholarship (if not previously used), and additional financial aid is available.

PART 01 - SHOULD BE FILLED OUT BY THE STUDENT

First Name*

Answer required for "First Name"

Last Name*

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Date of Birth*

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Grade as of September 2026*

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10th Grade

11th Grade

Other:

Gender*

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Male

Female

Other:

Student Phone*

Number Required

Student Email*

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Student School*

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Shirt Size*

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XXL

Please describe your extracurricular activities. Please be sure to include any Israel-related activities as well.*

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Have you been to Israel before? If yes, please list when you were there and what type of trip it was (i.e. day school, family trip, etc.)*

Answer required for "Have you been to Israel before? If yes, please list when you were there and what type of trip it was (i.e. day school, family trip, etc.)"

Essay Questions - Please select one of the questions and answer in 100-150 words in the box below. Please indicate which question you are answering at the top of your essay (not included in the word count)

Option 1: icnext is not just a trip to Israel. It is a two year commitment that includes 8 pre-trip sessions, a mission to Israel, and a year two fellowship. Why would you like to participate in this program?

Option 2: As a Jewish teen in Cleveland, what does your relationship with Israel look like today? Feel free to share positive and/or challenging experiences.

Your Answer*

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Academic Reference - please list name, relationship to participant, and reference email*

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Personal Reference - please list name, relationship to participant, and reference email

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PART 02- SHOULD BE FILLED OUT BY PARENT

IMPORTANT MEDICAL INFORMATION (Allergies, prescriptions, illness presently under physician's care, etc.)

HEATH INSURANCE CARD 01 - Please upload image or pdf copy of the student Health Insurance (card front)*

Answer required for "HEATH INSURANCE CARD 01 - Please upload image or pdf copy of the student Health Insurance (card front)"

Choose a file or drag it here.

HEATH INSURANCE CARD 02 - Please upload image or pdf copy of the student Health Insurance (card back)*

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Choose a file or drag it here.

Describe any health-related concerns (e.g. heart problems, diabetes, etc.):

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Medication Responsibility. Please select one:*

Answer required for "Medication Responsibility. Please select one:"

My child does not take any medication

My child will carry and self-administer their medication

I give permission for staff to hold and administer my child’s medication as needed

Current Medications: Please list all medications your participant is currently taking. Include: Medication name Dosage Frequency (e.g., once daily, as needed) Administration instructions (e.g., with food, time of day, etc.)

Answer required for " Current Medications: Please list all medications your participant is currently taking. Include: Medication name Dosage Frequency (e.g., once daily, as needed) Administration instructions (e.g., with food, time of day, etc.)"

Dietary Requirements - All meals provided will be kosher-style. As local catering options are limited, if your child requires strictly kosher (hechshered/sealed) meals, please contact Sydney Milgrom*

Answer required for "Dietary Requirements - All meals provided will be kosher-style. As local catering options are limited, if your child requires strictly kosher (hechshered/sealed) meals, please contact Sydney Milgrom"

None

Vegetarian

Vegan

Gluten-free

Dairy-free

Other:

Are there any learning needs, accommodations, or supports that would help us create the best experience for your teen?

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PARENTS INFORMATION

Parent 1 First Name*

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Parent 1 Last Name*

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Parent 1 Phone*

Number Required

Parent 1 Email*

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Parent 2 First Name

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Parent 2 Last Name

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Parent 2 Phone

Number Required

Parent 2 Email

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Address*

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City*

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State*

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Zip Code*

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ADDITIONAL INFORMATION

Non-Parent Emergency Contact Name*

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Non-Parent Emergency Contact Relationship to Participant *

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Non-Parent Emergency Contact Phone Number*

Number Required

All Jewish students in Cleveland are eligible to apply for Gift of Israel, a one-time $1800 scholarship to be used towards an Israel trip. If you have not yet used your Gift of Israel scholarship for another trip, do you plan to use it for the icnext mission trip?*

Answer required for "All Jewish students in Cleveland are eligible to apply for Gift of Israel, a one-time $1800 scholarship to be used towards an Israel trip. If you have not yet used your Gift of Israel scholarship for another trip, do you plan to use it for the icnext mission trip?"

Yes

PARENT OR GUARDIAN SIGNATURE

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

ICNEXT 15 APPLICATION FORM