Fellowship 26 application

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

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 education*

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

yes

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

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

Pelase share the kinds of emotional or mental health concerns you most often see arise in your community.*

Please describe the biggest challenge(s) you face when supporting individuals with mental health concerns in your communal role. Please include an example of a time when you feel unsure, stuck, or in need of additional guidance or training.

Goals*

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

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.

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*

APPLICATION

Apply Now – Acceptances Issued on a Rolling Basis (Deadline: March 22)

Reference and Recommendation