MailChimp Tag / Form Name
Memo
Notes to internal Federation professionals
Will the product list field be used for this form?
*
yes
no
Appeal code
Student to Student Application
Name
*
First Name
Last Name
Email
*
Confirmation Email
Confirm email address
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Will you be able to drive yourself to presentations?
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Yes
No
Yes, once I get my license
Date receiving license
-
Month
-
Day
Year
Date
I would describe my Jewish practice as:
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Conservative
Israeli
Just Jewish
Jewish Secular
Reform
Reconstructionist
Orthodox
Unaffiliated
Other
Congregation affiliation, if any (name and location):
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School name:
*
Grade, as of September 2026:
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Please inform us below of any allergies and any dietary requirements you have.
*
Please enter "none" if not applicable
Why I want to be a Student to Student Ambassador:
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Describe a meaningful Jewish tradition, holiday, or experience that has shaped your identity. Why is it important to you?
*
This program involves speaking in front of peers from different backgrounds. List any times you spoke in front of a group and what strengths you brought and challenges you faced.
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Student to Student meets every other month on Sunday from 10:00-12:00. In addition, there are presentations each month that you are expected to present at least 3. What other commitments have you made that could potentially conflict with this program?
Parent / Guardian Information
Parent / Guardian Name
*
First Name
Last Name
Parent / Guardian Email Address
*
Confirmation Email
example@example.com
Parent / Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent / Guardian Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent 2 / Guardian Name
First Name
Last Name
Parent 2 / Guardian Email Address
Confirmation Email
example@example.com
Parent 2 / Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent 2 / Guardian Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I understand that my/our picture may be taken at this event and it may appear on various channels, including social media and the Federation website.
SUBMIT
paymentData
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paymentData setup
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