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* First Name

* Last Name

* Date of Birth

* Email Address

* Cell Phone

* Home Phone

* Marital Status

Level of Education

May include current grade or schooling.

* Occupation

* What is your Jewish Educational Background?

* What would you like to learn about?

Character Development/MiddotGemara / TalmudPurity of SpeechHalacha / Jewish LawMishnaParsha / Weekly Torah PortionNavi / ProphetsChumashBasic JudaismPlease select 2.

* What other topics interest you?

* I identify as

* About My Family: Mom

* About My Family: Dad

* About My Family: Spouse

* Which of these have you been a part of?

Hebrew SchoolJewish Summer CampYear Abroad in IsraelSynagogue ClassesJewish Day SchoolNot YetCheck all those that apply.

* What days and times are you most available?

* How did you hear about us?

If from a friend, please provide her/his name.

* Someone who can tell us more about you (Name & Relationship)

* Someone who can tell us more about you (Phone #)

* Mentor or Mentee

Please Select OneI would like to learn (mentee)I would like to teach (mentor) (You must be at least 19 years of age to be a mentor in this program.)

Mon, August 4 2025 10 Av 5785

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