OPTION 1: Complete one of the applications listed on the right
and send via regular mail to:

The Ben Appelbaum Foundation
2 Briarcliff Drive
Port Washington, NY 11050
Phone/Fax: 516.883.0488

Or via email:

info@b-a-f.org

OPTION 2: Fill out the online application form:

* Required

First Name:*
Last Name:*
Email Address:*
Phone Number (home):*
Phone Number (cell):*
Fax Number:
Address 1:*
Address 2:
City:*
State:*
Zip Code:*
   
PROPOSAL  
   
Identification  
  Description of your venture:  
  What inspired you to attempt this venture (origin of idea):  
  Reasons that you think your venture will be successful:  
  Ways this venture relates to your personal goals:  
Brief Outline  
  Outline your approach to start this venture:  
     
  Indicate money requirements for start-up costs and longer term:
Benefits of Venture  
  How will your venture contribute to the community?  
  What specific jobs do you foresee being created?  
  How will success in your venture benefit you?  
PERSONSAL PROFILE  
  What are you presently doing in your work life?  
     
  What would you prefer doing?  
     
  Tell what about your life circumstance that is preventing you from doing what you really want to be doing:  
     
  What do you enjoy doing in your free time?  
     
  Whom do you admire and why did you select this individual?   
     
  Provide any additional relevant information that you feel would be helpful in knowing more about you:  
     
  Have you ever been convicted of a crime? If so, please explain:  
  Please email or mail us the face sheet of the last two year's tax returns; or if your business is a non-profit, please provide a copy of the 501c(3) approval.
BIOGRAPHICAL INFORMATION  
  Educational Background  
  Schools attended and dates of graduation:  
     
  Degrees achieved:  
     
  Major areas of study:  
  Employment History  
  Details:  
  Activities  
  Recreational:  
     
  Community/Civic:  
     
  Awards and recognition:  
REFERENCES  
Please include a list of three individuals (not related to you) who are sufficiently familiar with you to render an opinion about your character and likelihood of achieving success:
  Name :  
  E-mail :  
  Name :  
  E-mail :  
  Name :  
  E-mail :  
     
ADDITIONAL INFORMATION
   
   

By submitting this application, I hereby authorize The Ben Appelbaum Foundation and its Representatives or Agents to receive Credit Reporting, Criminal Records and or Motor Vehicle Records pertaining to me by which may be in the files of Experian, Trans Union, Equifax or the Department of Public Safety, solely for evaluation of mentee suitability.

 

 
DOWNLOADABLE APPLICATIONS:
Candidate Application in MS Word format
Candidate Application in PDF format

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