Please return this form to:
AJ Heschel Honor Society
155 Fifth Avenue
New York, New York 10010
212-533-7800
Or FAX it to 212-353-9439


Date_______________________________________

Name _____________________________________

Street Address ______________________________

City State Zip _______________________________

Phone _________ _________ _________ Grade ___

Synagouge______________ Region _____________

I fulfill the TORAH requirement by (circle one):
a) Attending Hebrew High School
b) USY Home Study Program
c) Private Study With A Teacher:
Describe your course of study
d) Attending A Jewish Day School

Describe your G'MILUT HASADIM project below:

_________________________________________

_________________________________________

_________________________________________

_________________________________________

I attended the required number of religious services (Initial Here) ____

I pledge to take my standardized tests on a non-Saturday date _____

Sponsorship: I wish to sponsor the above USYer as a member of the Abraham
Joshua Heschel Honor Society of United Synagouge Youth. S/he fulfills all the
requirements, including: TORAH study (at least 2 hours per week); AVODAH (attends
synagouge services at least 4 times a month, three of which are on Shabbat);
G'MILLUT HASADIM (involvement in a community service project at least 3 hours
per month.)

Sponsor Name ____________________________________

Street Address ____________________________________

City _________ _________ ____State_____ Zip _________

Phone _________ _______Signature __________________

Relationship to USYer_______________________________