IAC MAGEN for teens Fellowship Group #1

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Parent/Guardian Information

Parent/Guardian Name

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Parent/Guardian Email

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Parent/Guardian Phone Number

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Address

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Attendance & Participation Commitment

By checking the box below, I confirm that the program dates work for me, that I can commit to the full program, that participants are required to attend at least 80% of all program sessions, and that special events, educational tours, field trips, and other program activities are mandatory components of the program.

Parent/Guardian Commitment & Acknowledgment

I understand that the IAC MAGEN Teen Fellowship is a selective, year-long leadership program and that acceptance is based on a limited number of available spots.

I recognize that participation in the Fellowship represents a significant investment of resources, professional staff time, mentorship, programming, and subsidized costs provided by the IAC and its supporters.

By signing below, I commit to supporting my child’s active participation throughout the program year, including attendance at Fellowship sessions, engagement in program activities, and timely communication regarding any unavoidable absences.

I understand that the success of the Fellowship depends on the commitment of each participant and family, and I will make every reasonable effort to ensure my child fulfills this commitment.

Participant Information

Participant Name

First NameLast Name

Participant Email

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Participant Phone Number

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Participant Date of Birth

Date

Participant Gender

Participant Identity

Grade

Name of School

Graduation Date

Date

Do you have any allergies?

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Do you have and dietary restrictions?

If Dietary restriction Yes (please describe below)

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Do you have any medical conditions or special needs?

Medical conditions and special needs

T-Shirt Size

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Why are you interested in participating in the IAC MAGEN Teen Fellowship? Please describe what motivates you to apply and what you hope to gain from this experience. (150–250 words)

What role do you believe teens can play in shaping their schools, communities, and society? (150–250 words)

Do you currently hold any leadership positions or take an active role? If yes, please describe your role(s) and responsibilities. Examples: Student Council, club leadership, Scouts (Tzofim), youth groups, sports team captain, volunteer programs, community initiatives, etc.

If you are accepted into the Fellowship, what is one project, idea, or change you would like to create in your school or community? This does not need to be fully developed - we are interested in your ideas and vision. (150–250 words)

Program Fee

IAC Magen Teens Fellowship ATL - Single Ticket

$360.00

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Campaign Name

IAC MAGEN for teens Fellowship #1 - ATLANTA 26-27

Program Fee*

Program Fee