Student Programs Inquiry Form

After completing this form, you will be added to our mailing list and receive information on upcoming opportunities.

Name(Required)

Preferred First Last

Email(Required)

Are you a student, parent/guardian of a student, or educator? If you fall within a different role, please send us an email inquiry at HolocaustCenter@JFCS.org.(Required)

I am a middle school student.

I am a high school student.

I am a college student

I am a parent/guardian of a high school student.

I am an educator.

Student Information

Pronouns

She/Her/Hers

He/Him/His

They/Them

Other

Cell Phone(Required)

Where do you live?(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Where do you go to school?(Required)

Is this a private or a public school?(Required)

Private

Public

Other

Grade(Required)

6 – 8

undergraduate

graduate

Educator Inquiry for High School Student(s)

Where do you teach/work?(Required)

How many students do you serve?(Required)

What class, club, or program are you looking to share school program information with?(Required)

What grade level are the students you work with?(Required)

6 – 8

undergraduate

graduate

Parent/Guardian Inquiry for High School Student

Your Cell Phone(Required)

Your Studen't Name(Required)

Preferred First Last

Your Student Email(Required)

What grade is your student in?(Required)

Is this a private or a public school?(Required)

Private

Public

Other

Where does your student live?(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Is your student aware you are filling out the inquiry form on their behalf?

Yes

Other

Have you participated in a JFCS program before? Please check ALL that apply.(Required)

Conversation Circle

Manovill Seminar

The Next Chapter

Internship with JFCS YouthFirst

I've volunteered with JFCS

I attended a workshop

I attended the Day of Learning

No, I have not participated in a JFCS program before.

Other

How did you hear about the JFCS Holocaust Center? Please check ALL that apply.(Required)

An email from JFCS

My teacher/ school

Facebook/ Instagram/ Twitter

Friend

Family

Colleague

Postcard in the mail

Web search

Other

Interested in bringing a survivor to your school through our Speakers Bureau Program?(Required)

Yes

I want to learn more.

Interested in service opportunities from our partners with Youth First? Register for events here.

Anything else?

Thank you for your interest! You will be contacted by a JFCS Holocaust Center staff person. If you have any questions in the meantime, please feel free to reach out to us at holocaustcenter@jfcs.org. Don't forget to 'like' us on Facebook, and follow us on Instagram & Twitter.

Comments

This field is for validation purposes and should be left unchanged.

Student Information

Educator Inquiry for High School Student(s)

Parent/Guardian Inquiry for High School Student

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