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This document is an Aliyah questionnaire used to process applications for immigration to Israel. It requests personal details about the applicant such as name, date of birth, citizenship, passport information, family details, education history, Hebrew language ability, military service history, and previous connections to Israel. Similar details are also collected for the applicant's spouse and children under age 25 who will be making Aliyah. The applicant must sign declaring the information is accurate and that they have not committed criminal offenses or acts against Israel or Jewish people.
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- 1. ALIYAH QUESTIONNAIRE For office use: File number: ___________ Date received: __________ Aliyah Shaliach: ___________________ Aliyah Representative: ___________________ Expected Aliyah Date: ___ /___/_____ This questionnaire is the basic document used for processing your Aliyah application. Please provide all of the relevant details, so that we can give you prompt attention and accurate information. Please write clearly in block letters; put an x or check the appropriate places; if a question is not applicable, please indicate this with "N/A". Questions regarding your background are designed to provide an overall picture that will help those assisting in your Aliyah preparation to anticipate your absorption needs. Some of this information is also used for statistical purposes. If you have any questions about filling in the application, please feel free to contact your local Aliyah office or the Global Aliyah Center. You can find a list of toll free numbers at www.jewishagency.org/English/ APPLICANT – PERSONAL DETAILS Please write your name as it appears in your passport Last name: First name: Maiden name (if applicable): Former names (if applicable): Date of birth: _____/______/_______ (dd/mm/yyyy) Gender: Male Female Marital status: single married separated divorced widowed partners Religion: Jewish other (specify) Mother’s full name: Mother’s maiden name: Father’s full name: Father’s former name (if applicable): Israeli ID number (if applicable): Religious affiliation (check one or more): Orthodox Traditional Conservative Progressive Reform Reconstructions Secular Other (specify) 1
- 2. Country of birth: Nationality: Additional nationality/ies (if applicable): Passport # (including letters): Country issuing passport: Country of residence (where you have lived in the year prior to your Aliyah): Do you have a valid driving license? Yes No (In the country where you have lived in the year prior to your Aliyah) Occupation: Education: High school some college Bachelor’s Degree Master’s Degree PhD Yeshiva other (please specify) Have you been a member of youth organizations/ movements? If so, which one(s): Have you ever been to Israel? Yes No Have you ever been: Israeli citizen, temporary resident, permanent resident, Oleh, or none of these? If yes, what year(s)? Have you ever owned a home in Israel? Yes No If yes, do you still own it? Yes No if no, when was it sold? I have / have not spent more than 18 months in Israel in the past 3 years. I have / have not spent more than 3 years in Israel in the past 7 years. Have your parents ever lived in Israel? Yes No Have your parents ever been Israeli citizens? Yes No Have you served in the military? No Yes, IDF Yes, other (specify) ______________ HEBREW KNOWLEDGE- RANK YOUR KNOWLEDGE FROM 0 TO 5, WITH 0 AS NONE, 5 AS FLUENT Speaking reading writing 2
- 3. I WOULD LIKE TO APPLY FOR A VISA FOR: Immigration (Oleh visa) Temporary residency (A1) Other DECLARATION - please check one I declare that I have not committed any criminal offense. I declare that I have not committed any act directed against the Jewish people or the security of the State of Israel. There is no judicial warrant of arrest against me and I am not wanted by the police of any country. I confirm that the information on this questionnaire is full and accurate, and has been provided in the awareness of the fact that it will serve as a basis for the consideration of my application. I will notify the Aliyah office of any changes occurring prior to my Aliyah ___________________________________________ Signature of Applicant The aliyah questionnaire was signed before ____________________________ Date:_____________________ ___________________________________ Signature of Jewish Agency Representative Please attach a photo and a photo of spouse (if applicable) 3
- 4. SPOUSE – PERSONAL DETAILS Please write your name as it appears in your passport Last name: Firs name: Maiden name (if applicable): Former names (if applicable): Date of birth: _____/______/_______ (dd/mm/yyyy) Gender: Male Female Marital status: single married separated divorced widowed partners Religion: Jewish other (specify) Mother’s full name: Mother’s maiden name: Father’s full name: Father’s former name (if applicable): Israeli ID number (if applicable): Religious affiliation (check one or more): Orthodox Traditional Conservative Progressive Reform Reconstructions Secular Other (specify) Country of birth: Nationality: Additional nationality/ies (if applicable): Passport # (including letters): Country issuing passport: Country of residence (where you have lived in the year prior to your Aliyah): Do you have a valid driving license? Yes No (in the country where you have lived in the year prior to your Aliyah) Occupation: Education: High school some college Bachelor’s Degree Master’s Degree PhD Yeshiva other (please specify) Have you been a member of youth organizations/ movements? If so, which one(s): 4
- 5. Have you ever been to Israel? Yes No Have you ever been: Israeli citizen, temporary resident, permanent resident, Oleh, or none of these? If yes, what year(s)? Have you ever owned a home in Israel? Yes No If yes, do you still own it? Yes No if no, when was it sold? I have / have not spent more than 18 months in Israel in the past 3 years. I have / have not spent more than 3 years in Israel in the past 7 years. Have your parents ever lived in Israel? Yes No Have your parents ever been Israeli citizens? Yes No Have you served in the military? No Yes, IDF Yes, other (specify) ______________ HEBREW KNOWLEDGE- RANK YOUR KNOWLEDGE FROM 0 TO 5, WITH 0 AS NONE, 5 AS FLUENT Speaking reading writing I WOULD LIKE TO APPLY FOR A VISA FOR: Immigration (Oleh visa) Temporary residency (A1) Other DECLARATION – please check one I declare that I have not committed any criminal offense. I declare that I have not committed any act directed against the Jewish people or the security of the State of Israel. There is no judicial warrant of arrest against me and I am not wanted by the police of any country. I confirm that the information on this questionnaire is full and accurate, and has been provided in the awareness of the fact that it will serve as a basis for the consideration of my application. I will notify the Aliyah office of any changes occurring prior to my Aliyah 5
- 6. ___________________________________________ Signature of Applicant The aliyah questionairre was signed before ____________________________ Date:_____________________ ___________________________________ Signature of Jewish Agency Representative CHILDREN - Please list all children under age 25. In addition, children over age 18 who will be making Aliyah should open their own Aliyah file. Is this child Israeli ID Date of birth Country of making First and last name Gender Number (dd/mm/yyyy) birth Aliyah with (If applicable) you? M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No M/F Yes / No Will the whole family be making Aliyah together? Yes No Do any of the above minor children have a parent who will not be making Aliyah? Yes No 6
- 7. CURRENT CONTACT DETAILS Address: City: State: Zip: Country: Home Phone: Email: Work phone: Spouse work phone: Cell phone: Spouse cell phone: PLANS UPON ARRIVAL IN ISRAEL Expected Aliyah date: Expected place of residence: Address: ________________________________________________________ Rental Relatives Other (please specify) __________________ Phone number in Israel: Are you interested in being matched with a volunteer family to assist you through your initial absorption period? Yes No Contact in Israel: Name and relationship: Address (include city): Phone number: 7