Madrichim Application 2017-18

Please be sure the STUDENT fills out the form.

Fill out this form to the best of your ability. There are three questions at the end that need a little more thought, so you might want to type your answers somewhere else and then paste them into these boxes.

For more information on what it means to be a Madrich, please check out our Madrichim page here .

First Name(*)
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Last Name(*)
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Email Address(*)
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Cell Phone Number(*)
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Home Phone Number(*)
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Incoming Grade (2017-18)(*)
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Secular School(*)
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Best Way to Contact You(*)
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You can select more than one option by holding control to select multiple.

Parent Email Address(*)
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Parent Cell Phone Number(*)
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Would you like to be a Madrich in Religious School?(*)
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Sundays, 9:30 - 11:30 a.m.

Would you like to be a Madrich in Hebrew School?(*)
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Wednesdays, 4:15 - 6:00 p.m.

What is your proficiency in the Hebrew language?(*)

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Can you help out with drop in before Hebrew School (3:40-4:10)?(*)
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Madrichim who help before Hebrew School will receive $5 per session. Drop in is our program before Hebrew School where students can come and buy snacks/hang out at Am Shalom - we often need help selling snacks, managing kids in the hallway, etc.

Are you interested in helping out with music for Sundays?
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Would you like to be considered to help out after Sunday School, from 11:30 a.m. - 1:00 p.m. (For 11th and 12th graders only)
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Are there any months of the year in which you anticipate NOT being available?

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This could be due to sports, shows, etc.

Have you participated in the Madrichim program in previous years?(*)
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What years did you participate as a Madrich previously?

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Who was/were your mentor teachers?
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Are there any teachers you'd like to work with?
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Note: You are not guaranteed to get your preference

Are there any grades you'd prefer to work with?

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Note: You are not guaranteed to get your preference

Please indicate interest in any of the following

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We sometimes want Madrichim to help out with other tasks. Some of these are in the classroom - others are not. Please indicate if you have an interest in being a Madrich that focuses on:

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Please check all that apply

Comments on Interests Above(*)
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Are there other activities that aren't mentioned? Do you have additional comments or questions regarding the above?

T-Shirt Size(*)
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What instruments do you play, or what are your musical talents?
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Please answer the following questions in full and thoughtfully. Please include at least 2-3 sentences.
Why do you want to serve as a Madrich(a)?(*)
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Please describe your strengths that will contribute to our Madrichim program, and explain why these strengths will make you a good Madrich(a)(*)
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What do you hope to gain from the experience?(*)
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If selected to participate in the Madrichim program, I will attend class weekly for the entire school year (at least 75% of classes), I will arrive to school 15 minutes before class begins, and I will stay for 5 minutes after class to help my teacher wrap up the day. If I cannot make it, I will let Am Shalom know a week in advance. I understand that, as a role model to my students and a responsible teammate with my mentor teacher, weekly and punctual attendance is crucial. I also understand that there will be mandatory training sessions throughout the year, and I will be required to attend these trainings in order to enhance my classroom skills and learn more about being a leader and a Madrich. My virtual signature below confirms that I understand these expectations and will abide by them if selected to participate in the Madrichim program, and understand there are consequences for not abiding by these guidelines.
E-Signature(*)
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