Fellowship - Application page

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Synagogue affiliation (name of synagogue)*

Role(s) in which you impact your community (Please check all that apply)*

Rebbetzin
Kallah Teacher
Kiruv Professional
Chinuch Professional
Other

Please elaborate on your "other" role.*

This role is*

Volunteer
Paid

Please describe your communal role in more detail and the context in which you work with community members.*

Please describe the population you engage with in your communal role.*

Professional employment outside of my communal role*

Yes
No

Profession, place of employment and description of role*

Education and employment*

Please list your educational degrees and institutions and previous places of employment.

Age range*

Mental heath training*

I have previously participated in mental health training programs and/or conferences

yes
no

Please share the name of the program, the host organization of the program and a short description of the program.*

Leadership training*

I have previously participated in leadership training and/or women's conferences:

yes
no

Please share the name of the program, the host organization of the program and a short description of the program.*

Please describe the challenges you face serving in your communal role*

Goals*

Please describe what you will gain from this fellowship and how it will impact your personal life and your communal work.

Commitment to program*

I understand that if awarded the fellowship, I will be expected to attend the full virtual course "live with video on" and attend the in-person seminar on July 14-15 in the tri-state area.*

Additional comments

The purpose of this course is to provide general information to assist you in your communal work with respect to when and how to refer to appropriate mental health professionals. This course is not intended, and should not be construed, as formal training, permission to practice as a mental health counselor or for certification or license in the mental health field.

consent*

I am not a mental health counselor and do not counsel in a professional way.*

consent*

I am not a coach and do not provide counseling in a coaching capacity.*

Reference and Recommendation

Please choose a reference who will send a letter of recommendation on your behalf. Letters should be sent to: ouwomen@ou.org with the subject line: Letter of Recommendation for (insert your name)

Name of recommender*

First Last

Email address of recommender*

recommendation agreement*

I understand that my application is not complete until the OU Women's Initiative receives my letter of recommendation and I will ensure that the letter is sent.*

APPLICATION

Reference and Recommendation