Name
*
First
Last
I am
*
Male
Female
Age
*
Please enter a number from
0
to
120
.
Email
*
Phone
*
Where do you currently live?
*
Baltimore
Chicago
Cleveland
South Florida
Israel
New England
New Jersey
New York
Los Angeles
Toronto
Are you currently in school?
*
Yes
No
Which school?
*
Which category best describes you?
*
I am a student in Yachad's school, IVDU
I am a participant in Yachad programming – AKA a “Yachad Member”
I used to be a participant in Yachad (“a member”) but now do things other than Yachad
I am a participant in another organization for individuals with developmental disabilities
I am a High School student in a Mainstream School
I am a mainstream peer at Yachad events or Yachad summer programs
I am a member of the NCSY-Yachad Siddur Initiative Leadership Cohort
I am an advisor at Yachad programs
I used to be a Yachad Advisor but am not actively involved in Yachad right now
I am a student at a college campus with JLIC
Is there anyone in particular you would like to connect with through this program?
*
No one in particular
Yes, I will specify below
Please provide us with their contact information.
*
How did you hear about this program?
*