Name
E-Mail address
Phone number
City of residence
Wife’s occupation
Husband’s occupation
Country of origin
Month/Year of aliyah

Children:
Please list sex, ages and grade of each child

For each child, please rate their level in each of the following skills on a scale of 1-10 (1 being poor, 3 being not so good, 5 being OK, 7 being good and 10 being excellent)

Spoken Hebrew
Written Hebrew
Reading Hebrew
Understanding Hebrew

How often does your husband travel during the year?
Approximately how long does he stay away for each trip?
Approximately how many days is he gone during the year (all trips combined)? How long approximately has he been traveling on business?
Did he regularly travel before you made Aliyah?

The following section is very subjective. We request objectivity as much as possible and that you only list "conditions" which have arisen since your husband’s absence. If a condition existed BEFORE aliyah and has now become exacerbated, please note that. If a condition affects more than one child, please list them all. Feel free to give as much information as you think accurately portrays the situation. The more you write, the more we learn.

Emotion
Please list below any emotional problems your children have suffered in the absence of their father. (Please list the age of the affected child).

Social
Please list below any social problems your children have suffered in the absence of their father. (Please list the age of the affected child).
Are they having trouble making new friends?
Do they tend to hang out more with children who only speak their native language?

Behavior
Please list below any behavioral problems your children have suffered in the absence of their father. (Please list the age of the affected child).

Education
Please list below any educational problems your children have suffered in the absence of their father. (Please list the age of the affected child).

Do(es) your child(ren) show less interest in attending school?
Approximately how many hours a week does your husband spend studying with each child (not combined)?
Is this more or less than before Aliyah?
Have your child’s grades gone down since you made Aliyah?
If yes:
By how much (from what to what)
In specific subjects or across the board? If specific subjects please specify:

This section is for the spouse of the traveler:
Have you started, stopped in the middle,finished ulpan or not attended at all?
How has your husband’s absence affected you emotionally and socially?
Do you feel like you have more or less time for yourself than before he began working abroad?

Would you recommend to a family of potential olim who are considering the same arrangement:
Not to come at all
Do not come until you find work in Israel
Commute temporarily but look for work in Israel ASAP
Come even if you have to commute to your native country