Name
*
First
Last
Email
*
Age
*
Grade
*
School
*
What is your level of Jewish observance?
*
Secular
Reform
Conservative
Orthodox
Chassidic
Other
Other level of observance
How do you best communicate?
*
Orally
Sign Language
Cued Speech
Other
Other form of communication
What do you use for amplification?
*
Hearing Aids
Cochlear Implants
BaHa
Nothing
In this section we want to get to know you a little better to be able to connect you with a peer you’ll have the most in common with.
What is your favorite subject in school?
*
What is your least favorite subject?
*
What is your favorite thing to do outside of school?
*
What are your hobbies?
*
Do you have any hidden talents?
*
What is your favorite book?
*
What do you want to be when you get older?
*
Please write down any comments you may have!