Diller Teen Fellows Nomination Form 2018-2019

Diller Teen Fellows Nomination Form: 2018-2019

NOMINATIONS DUE: May 21, 2018

Please nominate current 9th or 10th graders from Philadelphia who demonstrate outstanding leadership qualities, dedication to community service, an interest in Jewish learning, and would like to strengthen their ties with Israel. Further qualities include: a commitment to contributing to the Jewish community, exceptional cooperation in peer groups, awareness of issues concerning Israel, outstanding communication skills, and a demonstration of maturity and thoughtfulness.

Diller Teen Fellows (Diller) is a year-long teen leadership program for 10th and 11th graders. Throughout the Program and together with our counterpart group in Herzliya, Israel, Fellows will develop Leadership skills, explore their Jewish Identity and connections to Israel and engage in meaningful Tikun Olam/Social Justice opportunities. Additionally, selected Fellows will participate in two Seminars: one in Philadelphia (Spring 2019) and one in Israel (Summer 2019). The Diller experience empowers its teens to be active, effective leaders with a strong Jewish identity and a respect for pluralism.

Diller Teen Fellows draws a diverse group of teenagers from different schools and levels of religious affiliation. Being part of Philadelphia's Diller Teen Fellows Program stimulates significant personal and communal growth. More details about Diller Teen Fellows programs can be found at: www.jewishphilly.org/teens.

If you know current 9th or 10th graders who demonstrate leadership qualities, possess strong communication and follow-through skills, and are dedicated to taking action in the community, please recommend these students for Diller Teen Fellows.

If you have any questions, please contact Rabbi Kami Knapp, Program Coordinator at 215.832.0823 or kknapp@jewishphilly.org

Your Information

Your Name*

First Name

Last Name

Jewish Agency & Title (if applicable)

Your Phone*

Your Email*

What is your relationship to the person you are nominating?*

Nominee Information

Name of Nominee*

First Name

Last Name

Gender of Nominee*

Current Grade*

High School

Nominee's Email*

Phone*

Address (if known)

Address Line 1

Address Line 2

City

State

ZIP Code

Parent's name (please list one)

First Name

Last Name

Parent's Email

Affiliations: Organization/School/Youth Group/Synagogue

Please rank the nominee in regard to their ability to demonstrate exceptional...*

Please rank the nominee in regard to their ability to demonstrate exceptional...
	5	4	3	2	1
Leadership qualities, communication skills, maturity and thoughtfulness	Please rank the nominee in regard to their ability to demonstrate exceptional...: Leadership qualities, communication skills, maturity and thoughtfulness (5)	Leadership qualities, communication skills, maturity and thoughtfulness (4)	Leadership qualities, communication skills, maturity and thoughtfulness (3)	Leadership qualities, communication skills, maturity and thoughtfulness (2)	Leadership qualities, communication skills, maturity and thoughtfulness (1)
Cooperation in peer groups, thriving in a process oriented, small group setting	Cooperation in peer groups, thriving in a process oriented, small group setting (5)	Cooperation in peer groups, thriving in a process oriented, small group setting (4)	Cooperation in peer groups, thriving in a process oriented, small group setting (3)	Cooperation in peer groups, thriving in a process oriented, small group setting (2)	Cooperation in peer groups, thriving in a process oriented, small group setting (1)
Dedication to community service, social action, and/or volunteerism	Dedication to community service, social action, and/or volunteerism (5)	Dedication to community service, social action, and/or volunteerism (4)	Dedication to community service, social action, and/or volunteerism (3)	Dedication to community service, social action, and/or volunteerism (2)	Dedication to community service, social action, and/or volunteerism (1)
Interest in Jewish learning and a commitment to contributing to the Jewish community	Interest in Jewish learning and a commitment to contributing to the Jewish community (5)	Interest in Jewish learning and a commitment to contributing to the Jewish community (4)	Interest in Jewish learning and a commitment to contributing to the Jewish community (3)	Interest in Jewish learning and a commitment to contributing to the Jewish community (2)	Interest in Jewish learning and a commitment to contributing to the Jewish community (1)
Willingness to engage in self-evaluation and to accept constructive criticism	Willingness to engage in self-evaluation and to accept constructive criticism (5)	Willingness to engage in self-evaluation and to accept constructive criticism (4)	Willingness to engage in self-evaluation and to accept constructive criticism (3)	Willingness to engage in self-evaluation and to accept constructive criticism (2)	Willingness to engage in self-evaluation and to accept constructive criticism (1)
Desire to strengthen their ties with Israel and an awareness of issues concerning Israel	Desire to strengthen their ties with Israel and an awareness of issues concerning Israel (5)	Desire to strengthen their ties with Israel and an awareness of issues concerning Israel (4)	Desire to strengthen their ties with Israel and an awareness of issues concerning Israel (3)	Desire to strengthen their ties with Israel and an awareness of issues concerning Israel (2)	Desire to strengthen their ties with Israel and an awareness of issues concerning Israel (1)

scale of 1-5, 5 being the highest

Thank you for taking the time to nominate an outstanding teen!